Expandable inter-body device, expandable plate system, and associated methods

ABSTRACT

The present disclosure provides for spinal implants and plates including, for example, expandable plates deployable between a contracted position and an expanded position. The expandable plate may include an expandable body including a first portion and a second portion. The first portion may include a receiving cavity facing the proximal end, and a first through aperture extending in the proximal-to-distal direction. The second portion may include a lower end having a size and shape that corresponds to the receiving cavity, and a second through aperture extending in the proximal-to-distal direction. The expandable plate may include a locking screw and a nut. In at least some embodiments, in a locked position, the locking screw extends through the first through aperture and second through aperture, and is secured to the nut. In various embodiments, in an expanded position the first portion and second portion are farther away from one another relative to a contracted position.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation in part of U.S. patent applicationSer. No. 17/246,932, titled Expandable Inter-Body Device, System, andMethod, filed May 3, 2021 which is a continuation in part of U.S. patentapplication Ser. No. 17/123,889, titled Expandable Inter-Body Device,System, and Method, filed Dec. 16, 2020 which claims priority to andincorporates by reference co-related patent applications,PCT/IB2020/000953, titled Expandable Inter-Body Device, System, andMethod, filed Nov. 5, 2020; PCT/IB2020/000932, titled Screwdriver andComplimentary Screws, filed Nov. 5, 2020; and PCT/IB2020/000942, titledExpandable Inter-Body Device, System, and Method, filed Nov. 5, 2020.The contents of each are hereby incorporated in their entireties.

FIELD

The present disclosure generally relates to medical devices for thetreatment of musculoskeletal disorders, and more particularly to asurgical device that includes an expandable spinal implant, systems forimplanting and manipulating the expandable spinal implant, and a methodfor treating a spine.

BACKGROUND

Spinal disorders such as degenerative disc disease, disc herniation,osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvatureabnormalities, kyphosis, tumor, and fracture may result from factorsincluding trauma, disease and degenerative conditions caused by injuryand aging. Spinal disorders typically result in symptoms including pain,nerve damage, and partial or complete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercisecan be effective, however, they may fail to relieve the symptomsassociated with these disorders. Surgical treatment of these spinaldisorders includes fusion, fixation, correction, discectomy, laminectomyand implantable prosthetics. As part of these surgical treatments,spinal constructs, such as, for example, bone fasteners, spinal rods andinterbody devices can be used to provide stability to a treated region.For example, during surgical treatment, interbody devices may beintroduced to a space between adjacent vertebral bodies (the interbodyspace) to properly space the vertebral bodies and provide a receptaclefor bone growth promoting materials, e.g., grafting.

More recently, interbody devices have been introduced that provideadditional capability beyond static spacing of the vertebral bodies. Forexample, some devices have expansion capability such that the implantmay be introduced to the interbody space in a collapsed state and thenexpanded to produce additional spacing and, in some cases, introduce orrestore curvature to the spine by expanding selectively. However, manyexisting expandable interbody designs have limited ranges of expansion.

An additional problem exists related to subsidence of spinal surfacesdue to existing interbody devices having inadequately-sized load-bearingsurfaces. In the case of expandable devices, the loads on theload-bearing surfaces, including loads generated during expansion of theimplant, are often significant. An expandable implant with relativelylarge surface areas is needed to bear the loads, including the loadsgenerated during implant expansion, in an attempt to avoid a need forfollow-on surgery due to subsidence of spinal surfaces.

A further problem is instability of existing expandable interbodydevices as they are expanded. Often, the load-bearing surfaces moverelative to one another, as well as relative to an inserter, as theinterbody device is expanded such that there is a risk of undesiredshifts in the positioning of the interbody device within theinterverterbral space. Additionally, and depending at least partly onthe particular insertion technique employed, anatomical features such asthe iliac crest and rib cage pose challenges to the adjustment ofinter-body designs in situ.

The present disclosure seeks to address these and other shortcomings inthe existing relevant arts.

SUMMARY

The techniques of this disclosure generally relate to highly adjustableinterbody devices that are expandable to selectively increase/decrease aspacing distance between endplates of the interbody device andadjustable to selectively increase/decrease an angle of inclinationbetween endplates of the interbody device. Additionally, at least insome embodiments, the techniques of this disclosure relate to a platethat may further be an expandable plate configured to be positionedexternal to and adjacent to a disc space that is securely connected toan adjustable interbody device configured to be positioned within thedisc space. For example, an interbody device may be positioned betweensuperior and inferior endplates and the expandable plate may be securelyconnected to the interbody device and be positioned outside of the discspace such that bone screws may selectively penetrate into the superiorand inferior endplates.

The details of one or more aspects of the disclosure are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the techniques described in this disclosurewill be apparent from the description and drawings, and from the claims.

In one aspect, the disclosure provides for an expandable plate and/orexpandable implant deployable between a contracted position and anexpanded position. In various embodiments, the expandable plate mayinclude an expandable body having a thickness in a proximal-to-distaldirection between a proximal end and a distal end, a width in awidthwise direction, and a height in a longitudinal direction, forexample. In various embodiments, the expandable body may include a firstportion and a second portion, for example. In various embodiments, thefirst portion may include a receiving cavity facing the proximal end,and a first through aperture extending in the proximal-to-distaldirection, for example. In various embodiments, the second portion mayinclude a lower end having a size and shape that corresponds to thereceiving cavity, and a second through aperture extending in theproximal-to-distal direction, for example. In various embodiments theexpandable plate may include a locking screw and a nut, for example. Inat least some embodiments, in a locked position, the locking screwextends through the first through aperture and second through aperture,and is secured to the nut, for example. In at least some embodiments,the expandable plate may be configured to couple to an implant, such asa spinal implant for example.

In another aspect, the present disclosure provides for a spinal implant.The spinal implant may include a superior endplate having a firstoutside surface and a first inside surface opposite the first outsidesurface, the first inside surface including first proximal ramps andfirst distal ramps disposed opposite the first proximal ramps, forexample. The spinal implant may include an inferior endplate including asecond outside surface and a second inside surface opposite the secondoutside surface, the second outside surface including second proximalramps and second distal ramps disposed opposite the second proximalramps, for example. In various embodiments, an endplate including aplurality of bone screw apertures and a central aperture may beprovided, for example. In various embodiments, a moving mechanism may becoupled to the superior endplate and the inferior endplate, for example.Additionally, the moving mechanism may include a buttress block and afirst trolley and a second trolley disposed on opposite sides of thebuttress block, and a rotatable first set screw and a rotatable secondset screw opposite the first set screw, for example. In variousembodiments, the first set screw and second set screw may be configuredto rotate in a first rotation direction and a second rotation directionabout a rotation axis projecting in a longitudinal direction of themoving mechanism, for example. Additionally, in various embodiments, thefirst trolley may be operably coupled to the first set screw and movabletoward and away the buttress block in the longitudinal direction of themoving mechanism by rotation of the first set screw along the rotationaxis, for example. Additionally, the second trolley may be operablycoupled to the second set screw and movable toward and away the buttressblock in the longitudinal direction of the moving mechanism by rotationof the second set screw along the rotation axis, for example. In variousembodiments, the moving mechanism may be configured to operably adjust aspacing between the superior and inferior endplates upon simultaneousrotation of the first and second set screws along the rotation axis, forexample. In various embodiments, the moving mechanism may be configuredto operably adjust an angle of inclination between the superior andinferior endplates upon rotating either one of the first set screw andsecond set screw along the rotation axis, for example. In variousembodiments, the spinal implant further comprises an expandable platedeployable between a contracted position and an expanded position, forexample. In various embodiments, the expandable body may have athickness in a proximal-to-distal direction between a proximal end and adistal end, a width in a widthwise direction, and a height in alongitudinal direction, for example. In various embodiments, theexpandable body may include a first portion and a second portion, forexample. In various embodiments, the first portion may include areceiving cavity facing the proximal end, and a first through apertureextending in the proximal-to-distal direction, for example. In variousembodiments, the second portion includes a lower end having a size andshape that corresponds to the receiving cavity, and a second throughaperture extending in the proximal-to-distal direction, for example. Invarious embodiments, a locking screw and a nut may be provided, forexample. In at least some embodiments, in a locked position, the lockingscrew extends through the first through aperture and second throughaperture, and is secured to the nut, for example. At least in someembodiments, the expandable plate is disposed proximate the anteriorendplate, for example.

In another aspect, a method for installing an expandable plate and anexpandable spinal implant, is disclosed. The method may include thesteps of providing an expandable spinal implant and providing a platethat may further be an expandable plate, for example. In variousembodiments, the expandable plate may include an expandable body havinga thickness in a proximal-to-distal direction between a proximal end anda distal end, a width in a widthwise direction, and a height in alongitudinal direction, for example. In various embodiments, theexpandable body may include a first portion and a second portion, forexample. In various embodiments, the first portion may include areceiving cavity facing the proximal end, and a first through apertureextending in the proximal-to-distal direction, for example. In variousembodiments, the second portion may include a lower end having a sizeand shape that corresponds to the receiving cavity, and a second throughaperture extending in the proximal-to-distal direction, for example. Invarious embodiments the expandable plate may include a locking screw anda nut, for example. In at least some embodiments, in a locked position,the locking screw extends through the first through aperture and secondthrough aperture, and is secured to the nut, for example. In at leastsome embodiments, the expandable plate may be configured to couple to animplant, such as a spinal implant for example. The method may furtherinclude the steps of inserting the expandable spinal implant betweenadjacent boney structures and installing a first bone screw that extendsthrough either one of the first bone screw aperture and second bonescrew aperture, for example.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1A is a perspective view of one embodiment of an expandable spinalimplant in a fully contracted position in accordance with the principlesof the present disclosure;

FIG. 1B is an exploded parts view of the embodiment of FIG. 1A inaccordance with the principles of the present disclosure;

FIG. 1C is a perspective view of one embodiment of an expandable spinalimplant in a contracted or closed configuration in accordance with theprinciples of the present disclosure;

FIG. 1D is a perspective view of one embodiment of an expandable spinalimplant in an expanded or opened configuration in accordance with theprinciples of the present disclosure;

FIGS. 2A and 2B are a top down views of the embodiment of FIGS. 1A and1B in accordance with the principles of the present disclosure;

FIGS. 2C and 2D are side views of the embodiment of FIGS. 1A and 1B in acontracted position in accordance with the principles of the presentdisclosure;

FIGS. 2E and 2F are side views of the embodiment of FIGS. 1A and 1B inan expanded position in accordance with the principles of the presentdisclosure;

FIG. 3A is a perspective view of one embodiment of an expandable spinalimplant in a closed configuration in accordance with the principles ofthe present disclosure;

FIG. 3B is a perspective view of one embodiment of an expandable spinalimplant in an expanded configuration in accordance with the principlesof the present disclosure;

FIG. 4A is a top down view of the embodiment of FIGS. 2A-2C inaccordance with the principles of the present disclosure;

FIG. 4B is a side view of the embodiment of FIGS. 2A-2C in a contractedposition in accordance with the principles of the present disclosure;

FIG. 4C is a side view of the embodiment of FIGS. 2A-2C in a partiallyexpanded and inclined position in accordance with the principles of thepresent disclosure;

FIG. 4D is a side view of the embodiment of FIGS. 2A-2C in a fullyexpanded position in accordance with the principles of the presentdisclosure;

FIG. 5A is a top down view of one embodiment in accordance with theprinciples of the present disclosure;

FIG. 5B is a front side view of the embodiment of FIG. 5A in accordancewith the principles of the present disclosure;

FIG. 5C is an alternate side view of the embodiment of FIG. 5A inaccordance with the principles of the present disclosure;

FIGS. 6A-6C are top down views of three exemplary footprint sizes of atop endplate in accordance with the principles of the presentdisclosure;

FIGS. 7A-7C are top down views of three exemplary footprint sizes of abottom endplate in accordance with the principles of the presentdisclosure;

FIG. 8 is perspective view of one embodiment of an expandable spinalimplant system in accordance with the principles of the presentdisclosure;

FIG. 9A is a cutout perspective showing a surgical tool in a firstadjustment position where an exemplary spinal implant is in a contractedposition;

FIG. 9B is a cutout perspective showing the surgical tool in the firstadjustment position after adjusting the exemplary spinal implant fromthe contracted position to a first expanded position;

FIG. 10A is a cutout perspective showing the surgical tool in a secondadjustment position where the exemplary spinal implant is in the firstexpanded position of FIG. 9B;

FIG. 10B is a cutout perspective showing the surgical tool in the secondposition after adjusting the exemplary spinal implant from the firstexpanded position to an expanded and angled position;

FIGS. 11A and 11B are perspective views of a moving mechanism in acontracted position and an expanded position, respectively, inaccordance with the principles of the present disclosure;

FIGS. 12A and 12B are perspective views of the moving mechanism of FIGS.11A and 11B in the contracted position and the expanded position,respectively, with a bottom endplate in accordance with the principlesof the present disclosure;

FIGS. 13A and 13B are perspective views of the moving mechanism of FIGS.12A and 12B in the contracted position and the expanded position,respectively, with a top endplate and the bottom endplate in accordancewith the principles of the present disclosure;

FIGS. 14A and 14B are cut-out views of a moving mechanism in accordancewith the principles of the present disclosure;

FIG. 15 is a cross section of the moving mechanism of FIGS. 14A and 14Balong a longitudinal axis thereof in accordance with the principles ofthe present disclosure;

FIG. 16 is a perspective view of a top endplate and bottom endplate ofone embodiment of an expandable spinal implant in accordance with theprinciples of the present disclosure;

FIG. 17 is an exploded view of the top endplate and bottom endplate ofFIG. 16 in accordance with the principles of the present disclosure;

FIGS. 18A-18B are perspective views of a first surgical tool of anexpandable spinal implant system in accordance with the principles ofthe present disclosure;

FIGS. 19A-19C are side views of first surgical tool and adjustment rodof an expandable spinal implant system, respectively, in accordance withthe principles of the present disclosure;

FIG. 20 illustrates a perspective view of one embodiment of anexpandable spinal implant system having anchoring screws in accordancewith the principles of the present disclosure;

FIGS. 21A-21B illustrate a lateral side view and front side view,respectively, of one embodiment of an expandable spinal implant systemhaving anchoring screws in accordance with the principles of the presentdisclosure;

FIG. 22A is a side view of a second surgical device suitable for usewith the embodiment of FIG. 20 in accordance with the principles of thepresent disclosure;

FIG. 22B is a side view of an enlarged region of FIG. 22A in accordancewith the principles of the present disclosure;

FIGS. 23A-23C are various perspective views of exemplary anchoringscrews suitable for use with the embodiment of FIG. 20 in conjunctionwith the second surgical tool of FIGS. 22A-22B in accordance with theprinciples of the present disclosure;

FIGS. 24A-24D are various side views and top down views of exemplarybone grafts in accordance with the principles of the present disclosure;

FIG. 25A and FIG. 25B illustrate a first bent position and a second bentposition, respectively, of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIGS. 26-28 illustrate a left side view, right side view, and front sideview, respectively, of an installed expandable spinal implant positionedbetween adjacent vertebral bodies in accordance with the principles ofthe present disclosure;

FIG. 29A is a perspective view of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIG. 29B is an exploded view of the embodiment of FIG. 29A in accordancewith the principles of the present disclosure;

FIG. 30A is a top down view of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIG. 30B is perspective view of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIG. 30C is a perspective view of one embodiment of an expandable spinalimplant with a top endplate removed in accordance with the principles ofthe present disclosure;

FIG. 30D is an alternate perspective view of one embodiment of anexpandable spinal implant with a top endplate removed in accordance withthe principles of the present disclosure;

FIG. 30E is a top down view of one embodiment of a top endplate inaccordance with the principles of the present disclosure;

FIG. 30F is a top down view of one embodiment of a bottom endplate inaccordance with the principles of the present disclosure;

FIG. 31 is a perspective view of one embodiment of an expandable spinalimplant system illustrating three alternate angular positions of aninsertion tool in accordance with the principles of the presentdisclosure;

FIG. 32A is a top down view of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIG. 32B is a perspective view of the embodiment of FIG. 32A inaccordance with the principles of the present disclosure;

FIG. 33A is a perspective view of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIG. 33B is a perspective view of the embodiment of FIG. 33A in anexpanded position in accordance with the principles of the presentdisclosure;

FIG. 33C is a perspective view of the embodiment of FIG. 33A in a firsttilted position in accordance with the principles of the presentdisclosure;

FIG. 33D is a perspective view of the embodiment of FIG. 33A in a secondtilted position in accordance with the principles of the presentdisclosure;

FIG. 34 is a perspective view of one embodiment of an expandable spinalimplant system in accordance with the principles of the presentdisclosure;

FIG. 35 is a perspective view of one embodiment of an expandable spinalimplant system illustrating three alternate angular positions of aninsertion tool in accordance with the principles of the presentdisclosure;

FIG. 36 is a perspective view of one embodiment of an expandable spinalimplant including a screw guide endplate having at least one apertureconfigured to receive a anchoring screw therein;

FIG. 37 is a front view of the embodiment of FIG. 36 ;

FIGS. 38A and 38B are various perspective views of a screw guideendplate having at least one aperture configured to receive a anchoringscrew therein;

FIGS. 39A and 39B are top down view of a top endplate and a bottomendplate including at least one slotted aperture configured to receive aanchoring screw therein;

FIG. 40 is a perspective view of one embodiment of an expandable spinalimplant including a screw guide endplate having at least one apertureconfigured to receive a anchoring screw therein;

FIG. 41 is a front view of the embodiment of FIG. 40 ;

FIG. 42A is a front views of a screw guide endplate having at least oneaperture configured to receive a anchoring screw therein;

FIG. 42B is a front view of the screw guide endplate of FIG. 42Aincluding anchoring screws installed in each of the correspondingapertures;

FIG. 43A and FIG. 43B are various perspective views of a screw guideendplate having at least one aperture configured to receive a anchoringscrew therein;

FIGS. 44A and 44B are top down views of a top endplate and a bottomendplate including at least one recessed portion configured toaccommodate a anchoring screw;

FIG. 45 is a perspective view of an additional embodiment of anexpandable spinal implant including an anterior endplate in accordancewith the principles of the present disclosure;

FIG. 46 is an alternate perspective view of the embodiment of FIG. 45 inaccordance with the principles of the present disclosure;

FIG. 47 is an exploded parts view diagram of the embodiment of FIG. 45in accordance with the principles of the present disclosure;

FIG. 48A is a first view of a bottom endplate of the embodiment of FIG.45 in accordance with the principles of the present disclosure;

FIG. 48B is a second view of a bottom endplate of the embodiment of FIG.45 in accordance with the principles of the present disclosure;

FIG. 48C is a perspective view of the embodiment of FIG. 45 in theexpanded position in accordance with the principles of the presentdisclosure;

FIG. 49 is a perspective view of the embodiment of FIG. 45 including aplurality of bone screws in accordance with the principles of thepresent disclosure;

FIG. 50 is an alternate perspective view of the embodiment of FIG. 45including a plurality of bone screws in accordance with the principlesof the present disclosure;

FIG. 51 is a rear perspective view of the embodiment of FIG. 45including a plurality of bone screws in accordance with the principlesof the present disclosure;

FIG. 52 is a side view of an example bone screw;

FIG. 53 is a reference diagram illustrating various cardinal directionsand planes with respect to a patient that the exemplary embodiments ofFIGS. 1-44B may operate, adjust, and/or move along in accordance withthe principles of the present disclosure;

FIG. 54 is a perspective view of a first expandable plate embodiment forcoupling to disclosed spinal implants;

FIG. 55 is an alternate perspective view of a first expandable plateembodiment for coupling to disclosed spinal implants;

FIG. 56 is a front view of a first expandable plate embodiment forcoupling to disclosed spinal implants;

FIG. 57 is a perspective exploded parts view of a first expandable plateembodiment for coupling to disclosed spinal implants;

FIG. 58 is an alternate perspective exploded parts view of a firstexpandable plate embodiment for coupling to disclosed spinal implants;

FIG. 59 is an alternate perspective exploded parts view of a firstexpandable plate embodiment for coupling to disclosed spinal implants;

FIG. 60 is a front view of a first expandable plate embodiment coupledto a spinal implant;

FIG. 61 is a cross section view of FIG. 60 ;

FIG. 62 is a perspective view of a second expandable plate embodimentfor coupling to disclosed spinal implants;

FIG. 63 is an alternate perspective view of a second expandable plateembodiment for coupling to disclosed spinal implants;

FIG. 64 is a front view of a second expandable plate embodiment forcoupling to disclosed spinal implants;

FIG. 65 is a perspective exploded parts view of a second expandableplate embodiment for coupling to disclosed spinal implants;

FIG. 66 is a perspective view of a second expandable plate embodiment inan expanded position;

FIG. 67 is an alternate perspective view of a second expandable plateembodiment in an expanded position;

FIG. 68 is a perspective view of a third expandable plate embodiment forcoupling to disclosed spinal implants;

FIG. 69 is an alternate perspective view of a third expandable plateembodiment for coupling to disclosed spinal implants;

FIG. 70 is a front view of a third expandable plate embodiment forcoupling to disclosed spinal implants;

FIG. 71 is a perspective exploded parts view of a third expandable plateembodiment for coupling to disclosed spinal implants;

FIG. 72 is a perspective view of a third expandable plate embodiment inan expanded position;

FIG. 73 is a perspective view of a third expandable plate embodiment inan expanded position; and

FIG. 74 is a flow chart of a method of operation of various expandableplates.

DETAILED DESCRIPTION

The exemplary embodiments of, for example, an anterior expandableinter-body device, lateral expandable inter-body device, inter-bodydevice systems, and inter-body device methods of use are discussed interms of medical devices for the treatment of musculoskeletal disordersand more particularly, in terms of various inter-body devices suitableas spinal implants for anterior surgical techniques, oblique surgicaltechniques, and lateral surgical techniques. Exemplary embodiments arealso discussed with related emphasis on specialized adjustmentinstruments such as, for example, an instrument capable of adjusting aspacing of the aforementioned various interbody devices between adjacentvertebrates of a spine by expansion and contraction as well as adjustingan angle of inclination with respect to the coronal plane and/orsagittal plane of a patient. Disclosed devices and systems may becapable of adjusting the curvature of a patient's spine for lordosiscorrection and a kyphosis correction. Likewise, an instrument capable ofinstalling various anchoring screws is described in conjunction withdisclosed inter-body devices.

As used herein, standard anatomical terms of location have theirordinary meaning as they would be understood by a person of ordinaryskill in the art unless clearly defined or explained otherwise. Itshould be understood that various aspects disclosed herein may becombined in different combinations than the combinations specificallypresented in the description and accompanying drawings. For example,characteristics of one embodiment may be combined or substituted withcharacteristics of another different embodiment unless thosecharacteristics are clearly explained as being mutually exclusive. Itshould also be understood that, depending on the example, certain actsor events of any of the processes or methods described herein may beperformed in a different sequence, may be added, merged, or left outaltogether (e.g., all described acts or events may not be necessary tocarry out the disclosed techniques and methods). In addition, whilecertain aspects of this disclosure are described as being performed by asingle module or unit for purposes of clarity, it should be understoodthat the techniques of this disclosure may be performed by a combinationof units or modules associated with, for example, a medical device.

In some embodiments, the present system includes an expandable spinalimplant suitable for insertion for oblique techniques, postero-lateralprocedures and/or transforaminal lumbar interbody fusions (sometimesreferred to as TLIF procedures), direct posterior (sometimes referred toas PLIF procedures), direct lateral (sometimes referred to as DLIFprocedures), anterior lumbar interbody fusions (sometimes referred to asALIF procedures), or variations of these procedures, in which thepresent implant is inserted into an interverterbral space and thenexpanded in order to impart and/or augment a lordotic and/or kyphoticcurve of the spine.

In some embodiments, the spinal implant system may also be employed torestore and/or impart sagittal balance to a patient by increasing and/orrestoring an appropriate lordotic and/or kyphotic angle betweenvertebral bodies at a selected level where the spinal implant isimplanted and expanded. Additionally, some embodiments may also beemployed to restore and/or impart coronal balance for correction of, forexample, scoliosis. In the various embodiments described, the spinalimplant system may be useful in a variety of complex spinal proceduresfor treating spinal conditions beyond one-level fusions. Furthermore,the spinal implant system described in the enclosed embodiments may alsobe used as a fusion device with an expandable height for tailoring theimplant to a particular interbody disc space to restore the spacingbetween adjacent vertebral bodies and facilitate spinal fusion betweenthe adjacent vertebral bodies.

In some embodiments, and as mentioned above, the present disclosure maybe employed to treat spinal disorders such as, for example, degenerativedisc disease, disc herniation, osteoporosis, spondylolisthesis,stenosis, scoliosis and other curvature abnormalities, kyphosis, tumorand fractures. In some embodiments, the present disclosure may beemployed with other osteal and bone related applications, includingthose associated with diagnostics and therapeutics. In some embodiments,the disclosed spinal implant system may be alternatively employed in asurgical treatment with a patient in a prone or supine position, and/oremploy various surgical approaches to the spine, including anterior,posterior, posterior mid-line, direct lateral, postero-lateral oblique,and/or antero lateral oblique approaches, and in other body regions. Thepresent disclosure may also be alternatively employed with proceduresfor treating the lumbar, cervical, thoracic, sacral and pelvic regionsof a spinal column. The spinal implant system of the present disclosuremay also be used on animals, bone models and other non-livingsubstrates, such as, for example, in training, testing anddemonstration.

The present disclosure may be understood more readily by reference tothe following detailed description of the embodiments taken inconnection with the accompanying drawing figures, which form a part ofthis disclosure. It is to be understood that this application is notlimited to the specific devices, methods, conditions or parametersdescribed and/or shown herein, and that the terminology used herein isfor the purpose of describing particular embodiments by way of exampleonly and is not intended to be limiting. In some embodiments, as used inthe specification and including the appended claims, the singular forms“a,” “an,” and “the” include the plural, and reference to a particularnumerical value includes at least that particular value, unless thecontext clearly dictates otherwise. Ranges may be expressed herein asfrom “about” or “approximately” one particular value and/or to “about”or “approximately” another particular value. When such a range isexpressed, another embodiment includes from the one particular valueand/or to the other particular value. Similarly, when values areexpressed as approximations, by use of the antecedent “about,” it willbe understood that the particular value forms another embodiment. It isalso understood that all spatial references, such as, for example,horizontal, vertical, top, upper, lower, bottom, left and right, are forillustrative purposes only and can be varied within the scope of thedisclosure. For example, the references “upper” and “lower” are relativeand used only in the context to the other, and are not necessarily“superior” and “inferior”. Generally, similar spatial references ofdifferent aspects or components, e.g., a “proximal end” of an end plateand a “proximal end” of a wedge, indicate similar spatial orientationand/or positioning, i.e., that each “proximal end” is situated on ordirected towards the same end of the device. Further, the use of variousspatial terminology herein should not be interpreted to limit thevarious insertion techniques or orientations of the implant relative tothe positions in the spine.

As used in the specification and including the appended claims,“treating” or “treatment” of a disease or condition refers to performinga procedure that may include administering one or more drugs, biologics,bone grafts (including allograft, autograft, xenograft, for example) orbone-growth promoting materials to a patient (human, normal or otherwiseor other mammal), employing implantable devices, and/or employinginstruments that treat the disease, such as, for example,micro-discectomy instruments used to remove portions bulging orherniated discs and/or bone spurs, in an effort to alleviate signs orsymptoms of the disease or condition. Alleviation can occur prior tosigns or symptoms of the disease or condition appearing, as well asafter their appearance. Thus, treating or treatment includes preventingor prevention of disease or undesirable condition (e.g., preventing thedisease from occurring in a patient, who may be predisposed to thedisease but has not yet been diagnosed as having it). In addition,treating or treatment does not require complete alleviation of signs orsymptoms, does not require a cure, and specifically includes proceduresthat have only a marginal effect on the patient. Treatment can includeinhibiting the disease, e.g., arresting its development, or relievingthe disease, e.g., causing regression of the disease. For example,treatment can include reducing acute or chronic inflammation;alleviating pain and mitigating and inducing re-growth of new ligament,bone and other tissues; as an adjunct in surgery; and/or any repairprocedure. Also, as used in the specification and including the appendedclaims, the term “tissue” includes soft tissue, ligaments, tendons,cartilage and/or bone unless specifically referred to otherwise. Theterm “bone growth promoting material” as used herein may include, but isnot limited to: bone graft (autograft, allograft, xenograft) in avariety of forms and compositions (including but not limited tomorselized bone graft); osteoinductive material such as bonemorphogenetic proteins (BMP) (including but not limited to INFUSE®available from Medtronic) and alternative small molecule osteoinductivesubstances; osteoconductive materials such as demineralized bone matrix(DBM) in a variety of forms and compositions (putty, chips, bagged(including but not limited to the GRAFTON® family of products availablefrom Medtronic)); collagen sponge; bone putty; ceramic-based voidfillers; ceramic powders; and/or other substances suitable for inducing,conducting or facilitating bone growth and/or bony fusion of existingbony structures. Such bone growth promoting materials may be provided ina variety of solids, putties, liquids, colloids, solutions, or otherpreparations suitable for being packed or placed into or around thevarious implants 100, 200, 300 and embodiments described herein.

The components of the expandable spinal implant systems described hereincan be fabricated from biologically acceptable materials suitable formedical applications, including metals, synthetic polymers, ceramics andbone material and/or their composites. For example, the components ofexpandable spinal implant system, individually or collectively, can befabricated from materials such as stainless steel alloys, commerciallypure titanium, titanium alloys, Grade 5 titanium, super-elastic titaniumalloys, cobalt-chrome alloys, stainless steel alloys, superelasticmetallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUMMETAL®), ceramics and composites thereof such as calcium phosphate(e.g., SKELITE′), thermoplastics such as polyaryletherketone (PAEK)including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) andpolyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO4 polymericrubbers, polyethylene terephthalate (PET), fabric, silicone,polyurethane, silicone-polyurethane copolymers, polymeric rubbers,polyolefin rubbers, hydrogels, semi-rigid and rigid materials,elastomers, rubbers, thermoplastic elastomers, thermoset elastomers,elastomeric composites, rigid polymers including polyphenylene,polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone materialincluding autograft, allograft, xenograft or transgenic cortical and/orcorticocancellous bone, and tissue growth or differentiation factors,partially resorbable materials, such as, for example, composites ofmetals and calcium-based ceramics, composites of PEEK and calcium basedceramics, composites of PEEK with resorbable polymers, totallyresorbable materials, such as, for example, calcium based ceramics suchas calcium phosphate, tri-calcium phosphate (TCP), hydroxyapatite(HA)-TCP, calcium sulfate, or other resorbable polymers such aspolyaetide, polyglycolide, polytyrosine carbonate, polycaprolactone andtheir combinations.

Various components of spinal implant system may be formed or constructedof material composites, including but not limited to the above-describedmaterials, to achieve various desired characteristics such as strength,rigidity, elasticity, compliance, biomechanical performance, durabilityand radiolucency or imaging preference. The components of expandablespinal implant system, individually or collectively, may also befabricated from a heterogeneous material such as a combination of two ormore of the above-described materials. The components of the expandablespinal implant systems may be monolithically formed, integrallyconnected or include fastening elements and/or instruments, as describedherein. For example, in some embodiments the expandable spinal implantsystems may comprise expandable spinal implants 100, 200, 300 comprisingPEEK and/or titanium structures with radiolucent markers (such astantalum pins and/or spikes) selectively placed in the implant toprovide a medical practitioner with placement and/or sizing informationwhen the expandable spinal implant 100, 200, 300 is placed in the spine.The components of the expandable spinal implant system may be formedusing a variety of subtractive and additive manufacturing techniques,including, but not limited to machining, milling, extruding, molding,3D-printing, sintering, coating, vapor deposition, and laser/beammelting. Furthermore, various components of the expandable spinalimplant system may be coated or treated with a variety of additives orcoatings to improve biocompatibility, bone growth promotion or otherfeatures. For example, the endplates 110, 120, may be selectively coatedwith bone growth promoting or bone ongrowth promoting surface treatmentsthat may include, but are not limited to: titanium coatings (solid,porous or textured), hydroxyapatite coatings, or titanium plates (solid,porous or textured).

The expandable spinal implant system may be employed, for example, witha minimally invasive procedure, including percutaneous techniques,mini-open and open surgical techniques to deliver and introduceinstrumentation and/or one or more spinal implants at a surgical sitewithin a body of a patient, for example, a section of a spine. In someembodiments, the expandable spinal implant system may be employed withsurgical procedures, as described herein, and/or, for example,corpectomy, discectomy, fusion and/or fixation treatments that employspinal implants to restore the mechanical support function of vertebrae.In some embodiments, the expandable spinal implant system may beemployed with surgical approaches, including but not limited to:anterior lumbar interbody fusions (ALIF), posterior lumbar interbodyfusion (PLIF), oblique lumbar interbody fusion, transforaminal lumbarinterbody fusion (TLIF), various types of anterior fusion procedures,and any fusion procedure in any portion of the spinal column (sacral,lumbar, thoracic, and cervical, for example).

Generally in FIGS. 1-44B, five exemplary embodiments of an expandablespinal implants 100, 200, 300, 600, and 700 are shown (spinal implant100 is highlighted in exemplary FIGS. 1-28 , implant 200 is highlightedin exemplary FIGS. 29-31 , implant 300 is highlighted in exemplary FIGS.32-35 , implant 600 is highlighted in exemplary FIGS. 36-39B, implant700 is highlighted in FIGS. 40-44B). Exemplary embodiments of surgicaltools 400, 450, and 500 are highlighted in exemplary FIGS. 8, 18-23C anddisclosed in conjunction with an inter-body spinal implant system. Forexample, surgical tools 400, 450, and 500 are discussed concurrentlywith exemplary spinal implant 100. It shall be understood that the sameor similar surgical tools highlighted in exemplary FIGS. 8, 18-23C maybe employed with expandable spinal implants 200, 300, 600, and 700.Similar and/or identical numbering of corresponding elements may be usedinterchangeably between the various exemplary embodiments of anexpandable spinal implants 100, 200, 300, 600, and 700 for ease ofunderstanding and convenience in explanation. For example, movingmechanism 250 is predominately discussed concurrently with exemplaryspinal implant 100 and is highlighted in exemplary FIGS. 9A-15 althoughthe same or similar moving mechanism 250 may be employed with expandablespinal implants 200, 300, 600, and 700. FIG. 53 is provided solely as areference illustration showing a patient 1 and various standard medicalterms and orientations with respect to cardinal directions and planes ofthe body of patient 1 in which expandable spinal implants 100, 200, 300,600, and 700 may act.

Referring generally to FIGS. 1-28 a first exemplary expandable spinalimplant 100, moving mechanism 250, first surgical tool 400, and secondsurgical tool 500 are illustrated. Spinal implant 100 may be configuredto be inserted in an intervertebral disc space between adjacentvertebral bodies accordingly to a variety of surgical techniques, e.g.,anterior techniques, oblique techniques, and lateral techniques.

FIG. 1A shows the spinal implant 100 in a perspective view and FIG. 1Bshows the spinal implant 100 in an exploded parts view. Exemplary spinalimplant 100 includes a top endplate 110 (first endplate) and a bottomendplate 120 (second endplate) and a moving mechanism 250, which will bedescribed in greater detail below. Spinal implant 100 includes aproximal end 101 and a distal end 102 opposite the proximal end 101, anda first lateral end 103 and a second lateral end 104 opposite the firstlateral end 103. The first and second lateral ends 103, 104 extendbetween the proximal end 101 and the distal end 102. The proximal end101 includes an exposed screw guide endplate 105 defining acorresponding screw guide aperture 107, which are disposed betweenendplates 110 and 120. The screw guide endplate 105 and guide aperture107 will be described in greater detail below.

Top endplate 110 may include a first outside surface 111 and a firstinside surface 112 opposite the first outside surface 111. Similarly,bottom endplate 120 may include a second outside surface 121 and asecond inside surface 122. The outside surfaces 111, 121 may beconfigured to be positioned between and/or contact vertebral bodies in apatients spine and have various surface characteristics. For example, insome embodiments, outside surfaces 111 and 122 may have a substantiallylinear surface profiles extending across faces of textured surfacesthereof. In other embodiments, outside surfaces 111 and 122 may havecurved surface profiles extending across faces of textured surfacesthereof. Further details of endplates 110, 120 will be described ingreater detail below. Inside surfaces 111, 122, may surround movingmechanism 250 and have various contours, guides, cavities, and otheroperable characteristics that facilitate movement and/or providemechanical advantage to other operable and movable corresponding partsto facilitate contraction, angular adjustment, lateral bending,absorption of compression forces, shear forces, etc. as will beexplained in greater detail below.

In the exemplary embodiment, top endplate 110 includes a pair of firstproximal ramps 114 and a pair of first distal ramps 116 opposite thefirst proximal ramps 114. Each ramp of the first proximal ramps 114includes an inclined surface extending away from inside surface 112 andmoving mechanism 250. Similarly, each ramp of first distal ramps 116includes an inclined surface extending away from inside surface 112 andmoving mechanism 250. Bottom endplate 120 includes a pair of secondproximal ramps 124 and a pair of second distal ramps 126 opposite thesecond proximal ramps 124. Each ramp of the second proximal ramps 124includes an inclined surface extending away from inside surface 122 andmoving mechanism 250. Similarly, each ramp of second distal ramps 126includes an inclined surface extending away from inside surface 112 andmoving mechanism 250. Furthermore, each ramp 114, 116, 124, 126 includesa corresponding guide wall 130 extending along an inside surface thereofand extending in a direction substantially parallel to the inclinedsurface of the corresponding ramp.

Exemplary spinal implant 100 includes a moving mechanism 250 that isoperably coupled to top endplate 110 and bottom endplate 120 as will beexplained in greater detail below. Moving mechanism 250 includes a firstset screw 252 and a corresponding first trolley 256 operably coupledthereto, and a second set screw 254 and a corresponding second trolley258 operably coupled thereto. A first functional feature of movingmechanism 250 is that it is further configured to increase and decreasea spacing between the top and bottom endplates 110, 120 uponsimultaneous rotation of the first and second set screws 252, 254 in aclockwise and counterclockwise direction, respectively. A secondfunctional feature of moving mechanism 250 is that it is furtherconfigured to increase and decrease an angle of inclination between thetop and bottom endplates 110, 120 upon rotation of the first set screw252 in a clockwise and counterclockwise direction, respectively.Additional functions and attributes of moving mechanism 250 will bedescribed in greater detail below.

FIG. 1C is a perspective view of spinal implant 100 in a contractedposition and FIG. 1D is a perspective view of spinal implant 100 in anexpanded position. In the contracted position of FIG. 1C, top endplate110 and bottom endplate 120 are contracted to a fully closed position.In the expanded position of FIG. 1B, top endplate 110 and bottomendplate 120 are expanded to a mid-way position, i.e., endplates 110 and120 can additionally expand if desired. In some embodiments, topendplate 110 may be referred to as an anterior wedge or anteriorendplate and bottom endplate 120 may be referred to as a posterior wedgeor posterior endplate.

As explained above, spinal implant 100 includes a proximal end 101 and adistal end 102 opposite the proximal end 101, and a first lateral end103 and a second lateral end 104 opposite the first lateral end 103. Itshall be understood that reference to other parts of spinal implant 100may be in terms of the above orientation with reference to spinalimplant 100 generally, e.g., endplate 110 may also include a proximalend 101 and a distal end 102 opposite the proximal end 101, and a firstlateral end 103 and a second lateral end 104 opposite the first lateralend 103.

FIGS. 2A and 2B illustrate a top down view of spinal implant 100. Spinalimplant 100 has a length L and a width W predominately defined by afootprint of endplates 110, 120. Spinal implant 100 has a firstreference axis A₁ and a second reference axis A₂. First reference axisA₁ may be understood as a projection passing through a central portionof guide aperture 107 in a direction parallel to an end surface of firstand second lateral ends 103, 104, e.g., first reference axis A₁ may passthrough the center of spinal implant 100 in a width wise direction.Second reference axis A₂ may be understood as a projection intersectingfirst reference axis A₁ and passing through the center of spinal implant100 in a length wise direction. Top endplate 110 may have a plurality ofchannels 111 c spaced apart from one another and extending in a lengthwise direction thereof, e.g., in a direction parallel with referenceaxis A₂. Similarly, bottom endplate 120 may have a plurality of channels122 c spaced apart from one another and extending in a length wisedirection thereof, e.g., in a direction parallel with reference axis A₂.In the exemplary embodiment, channels 111 c, 122 c may each have aninclined edge portion that assists with positioning the spinal implant100 between vertebral bodies and provides a surface for promoting bonegrowth thereon.

FIGS. 2C and 2D illustrate spinal implant 100 in a side view in acontracted position and FIGS. 2E and 2F illustrate spinal implant 100 ina side view in an expanded position. It shall be understood that FIGS.2C-2F schematically illustrate spinal implant 100 with some internalparts being illustrated or simplified and others being omit for ease ofexplanation. For example, FIGS. 2C-2F are illustrated schematicallysolely to assist in explaining various positions of first and secondendplates 110, 120 with respect to one another. In the contractedposition, a first height H_(1A) of proximal end 101 may be about 10 mmand in the expanded position a second height H_(1B) of proximal end 101may be about 22 mm. In the contracted position, a first height H_(2A) ofdistal end 102 may be about 7 mm and in the expanded position a secondheight H_(2B) of distal end 102 may be about 12 mm. Additionally, in thecontracted position, a first angle of inclination θ₁ between endplates110, 120 may be about 7° and in the expanded position a second angle ofinclination θ₂ between endplates 110, 120 may be about 25°. Althoughspecific ranges are provided herein with reference to exemplary spinalimplant 100, other embodiments may have alternate correspondingdimensions, i.e., height, from those provided above. Likewise, otherembodiments may have alternate corresponding angles of inclinationbetween endplates 110, 120.

FIGS. 3A and 3B are perspective view of an alternate embodiment of asecond spinal implant 200. Spinal implant 200 may have the samecharacteristics or similar characteristics as spinal implant 100. Asillustrated, spinal implant 200 includes a top patterned endplate 110 aand a bottom patterned endplate 120 a. Top patterned endplate 110 aincludes an outside surface 111 and an inside surface 112 opposite theoutside surface 111. Similarly, bottom patterned endplate 120 a includesa first outside surface 121 and a first inside surface 122 opposite theoutside surface 111. As illustrated, the outside surface 111 includes aplurality of raised diamond shaped surfaces 111 d (a diamond treadpattern) and a plurality of first openings 111 a that may each have adiamond like shape, a circular shape, and/or a diamond like shapeincluding chamfered or rounded corners. Although not visible in FIGS. 3Aand 3B, it shall be understood that bottom patterned endplate 120 a mayalso have a plurality of raised diamond shaped surfaces and a pluralityof openings the same as or similar to the plurality of raised diamondshaped surfaces 111 d and the plurality of first openings 111 a of toppatterned endplate 110 a.

As illustrated, the plurality of first openings 111 a are circular anddisposed in a central region of top patterned endplate 110 a, althoughthey may have alternate shapes and/or be disposed in alternate locationsin other embodiments. For example, first and second outside surfaces 111and 122 may comprise various anti-migration, anti-expulsion, and/orosseointegration features including, but not limited to: ridges, teeth,pores, and coatings (including but not limited to porous titaniumcoatings such as those provided on Capstone PTC™ implants available fromMedtronic). The endplates 110 a, 120 a may further comprise at least onesecond opening 115 defined therein, and configured to allow bone growthmaterials to be packed, placed, or loaded into spinal implant 200. Inthe exemplary embodiment a pair of second openings 115 are shown witheach having a D like shape.

FIG. 4A illustrates spinal implant 200 in a top down view and each ofFIGS. 4B-4D illustrate spinal implant 200 in a side view in a differentrespective position. FIG. 4B illustrates spinal implant 200 in a firstposition, FIG. 4C illustrates spinal implant 200 in a second positionand FIG. 4D illustrates spinal implant 200 in a third position. In thefirst position, a first height H_(1A) of proximal end 101 may be about10 mm, in the second position a second height H_(1B) of proximal end 101may be about 18 mm, and in the third position a third height Hic ofproximal end 101 may be about 18 mm. In the first position, a firstheight H_(2A) of distal end 102 may be about 6 mm, in the secondposition a second height H_(2B) of distal end 102 may be about 5 mm, andin the third position a third height Hic of distal end 102 may be about11.8 mm (approximately 12 mm). Additionally, in the first position, afirst angle of inclination θ₁ between endplates 110 a, 120 a may beabout 9°, in the second position a second angle of inclination θ₂between endplates 110 a, 120 a may be about 30°, and in the thirdposition a third angle of inclination θ₃ between endplates 110 a, 120 amay be about 13°. In some embodiments, the first position may correspondto a fully contracted position, the second position may correspond to amaximum inclination angle, and the third position may correspond to afully expanded position. Although specific ranges are provided hereinwith reference to exemplary spinal implant 100, other embodiments mayhave alternate corresponding dimensions, i.e., height, from thoseprovided above. Likewise, other embodiments may have alternatecorresponding angles of inclination between endplates 110 a, 120 a.

FIG. 5A is a top down view of a spinal implant 300. Spinal implant 300may have the same characteristics or similar characteristics as spinalimplant 200 and spinal implant 100. FIGS. 5B and 5C are alternate sideviews of the embodiment of FIG. 5A. As illustrated spinal implant 300includes a first reference axis A₁ and a second reference axis A₂. Firstreference axis A₁ passes through the center of spinal implant 300 in awidth wise direction and second reference axis A₂ passes through thecenter of spinal implant 300 in a length wise direction. First andsecond reference axes A₁ and A₂ may be understood as linear projectionsthat are perpendicular with respect to one another. Additionally, firstreference axis A₁ may pass through the center of guide aperture 107 andother components operably disposed therein, e.g., moving mechanism 250as will be discussed in greater detail below.

As illustrated, spinal implant 300 includes a top curved endplate 110 cand a bottom curved endplate 120 c. The top curved endplate 110 cfeatures a concave surface profile with respect to the first and secondreference axes A₁ and A₂ projecting thereunder. The concave surfaceprofile is emphasized by the curved line thereabove. The bottom curvedendplate 120 features a convex surface profile with respect to the firstand second reference axes A₁ and A₂ projecting thereabove. The convexsurface profile is emphasized by the curved line therebelow.

FIGS. 6A-6C are top down views of three exemplary footprint sizes of afirst top endplate 110 x, second top endplate 110 y, and third topendplate 110 z. It shall be understood that first, second, and third topendplates 110 x, 110 y, and 110 z may be substituted for endplates 110,110 a, and 110 c in accordance with the principles of the presentdisclosure. FIGS. 7A-7C are top down views of three exemplary footprintsizes of a first bottom endplate 120 x, second bottom endplate 120 y,and third bottom endplate 120 z. It shall be understood that first,second, and third bottom endplates 120 x, 120 y, and 120 z may besubstituted for endplates 120, 120 a, and 120 c in accordance with theprinciples of the present disclosure. First top endplate 110 x and firstbottom endplate 120 x may have a length of about 32 mm and a width ofabout 25 mm. Second top endplate 110 y and second bottom endplate 120 ymay have a length of about 37 mm and a width of about 29 mm. Third topendplate 110 z and third bottom endplate 120 z may have a length ofabout 42 mm and a width of about 32 mm. It shall be understood thatfirst top endplate 110 x and first bottom endplate 110 y are suitablefor patients with relatively small vertebrae, second top endplate 110 yand second bottom endplate 110 y are suitable for patients withrelatively larger vertebrae than the previous example, and third topendplate 110 z and third bottom endplate 110 z are suitable for patientswith relatively larger vertebrae than the previous two examples. In thisway, spinal implants 100, 200, and 300 may be configured to have any ofthe exemplary footprint sizes explained above depending on a particularpatient's vertebral anatomy. For example, as part of an initialassessment a surgeon may assess which of the available footprint sizesis best suited for a particular patient's vertebral anatomy. It shall beunderstood that the above exemplary footprint sizes are non-limitingexemplary embodiments and that other footprint sizes may be used withany of spinal implants 100, 200, 300 provided the chosen footprint sizeis suitable for a particular patient's anatomy. However, the threeexemplary footprint sizes explained above are generally suitable for themajority of patients.

FIG. 8 is a perspective view of one embodiment of an expandable spinalimplant system 1000 in accordance with the principles of the presentdisclosure. First surgical tool 400 includes a handle 402, shaft 404,tip 406, locking mechanism 408, and adjustment knob 452. Tip 406 isconfigured to be inserted inside of guide aperture 107 and operablyconnected to spinal implant 100. First surgical tool 400 is configuredto perform a variety of functions for operably manipulating spinalimplant 100. For example, first surgical tool 400 is configured tooperably engage with spinal implant 100 via a secured connection suchthat a spinal implant 100 may be inserted between vertebral bodies of apatient according to anterior surgical techniques, oblique surgicaltechniques, and lateral surgical techniques. Additionally, firstsurgical tool 400 is configured to operably engage with spinal implant100 to adjust spinal implant 100 from a contracted position to anexpanded position and vice-versa. Furthermore, first surgical tool 400is configured to operably engage with spinal implant 100 to adjust anangle of inclination between endplates 110, 120. Further still, spinalimplant 100 may be adjusted in situ between vertebral bodies afterspinal implant 100 is inserted into a patient. Additional attributes ofthe surgical tool will be disclosed below with reference to FIGS.18A-19B

FIG. 9A is a cutout perspective showing first surgical tool 400 in afirst adjustment position where the spinal implant 100 is in acontracted position and FIG. 9B is a cutout perspective showing firstsurgical tool 400 in the first adjustment position after adjusting thespinal implant 100 from the contracted position to a first expandedposition. As illustrated, tip 406 is inserted through guide aperture 107and into moving mechanism 250. Moving mechanism 250 includes a first setscrew 252 and a second set screw 254 having respective internal cavitiesconfigured to operably receive tip 406. In some embodiments, first setscrew 252 may be referred to as an anterior screw and second set screw254 may be referred to as a posterior screw. The first and second setscrews 252, 254 have a helical thread pitch that corresponds to keyedprojections of first and second trolleys 256, 258, respectively. In theexemplary embodiment, the second set screw 254 has a reverse threadpitch and a shorter length than first set screw 252. In someembodiments, the thread pitch may be an M6 thread pitch, however otherembodiments may have other thread pitches.

Each internal cavity of set screws 252, 254 comprises an internalcircumferential surface that is keyed to the outside circumferentialsurface 456 of tip 406 of first surgical tool 400. For example, theoutside circumferential surface 456 may resemble the geometry of the tipof a torx driver, hex driver, or the like and the internalcircumferential surfaces of the first and second set screws 252, 254 mayresemble the geometry of the cavity of the head of a torx screw, hexscrew, or the like. In some embodiments, the internal circumferentialsurfaces of the first and second set screws 252, 254 may be configuredfor a Torx T20 driver or the like, however other embodiments may bedifferently sized. In other embodiments, the connection between theouter circumferential surface 456 and the inner circumferential surfacesof first and second set screws 252, 254 may comprise a variety of driveinterfaces including but not limited to: multi-lobular drives;hexalobular drives; cross or Phillips head drives; straight or “flathead” drives; square or other polygonal drives; and/or combinationsthereof. It shall be understood that any suitable geometrical shape orsurface profile may be used by the exemplary embodiments disclosedherein provided the outside circumferential surface 456 is operablykeyed to engage with the internal circumferential surfaces of the firstand second set screws 252, 254.

In the exemplary embodiment, outside circumferential surface 456 isengaged with both the first and second set screws 252, 254 and whenfirst surgical tool 400 is rotated in a first direction (clockwisedirection) the outside circumferential surface 456 translates both setscrews 252, 254 thereby causing the first and second trolleys 256, 258to move away from one another in opposite directions. In turn, the firstand second trolleys 256, 258 cause the top and bottom endplates 110, 120to move apart from one another an equal amount in the expansiondirection indicated by the arrows. The expansion direction may be agenerally vertical direction projecting away from and perpendicular tothe generally horizontal direction of a rotation axis of the movingmechanism. Likewise, when first surgical tool 400 is rotated in a seconddirection (counter-clockwise direction) the outside circumferentialsurface 456 translates both set screws 252, 254 thereby causing thefirst and second trolleys 256, 258 to move towards one another (notillustrated). In turn, the first and second trolleys 256, 258 urge thetop and bottom endplates 110, 120 to move towards one another an equalamount in a contraction direction (not illustrated). The contractiondirection may be a generally vertical direction projecting towards andperpendicular to the generally horizontal direction of the rotation axisof the moving mechanism. In summary, when positioning the first surgicaltool 400 in the first position and rotating the first surgical tool 400in either the first or second direction the moving mechanism 250operably adjusts a spacing between the top and bottom endplates bysimultaneous rotation of the first and second set screws 252, 254 alongthe rotation axis.

FIG. 10A is a cutout perspective showing first surgical tool 400 in asecond adjustment position where the spinal implant 100 is in the firstexpanded position of FIG. 9B. As illustrated, first surgical tool 400 isretracted from moving mechanism 250 such that the outsidecircumferential surface 456 is only engaged with the first set screw252, i.e., first surgical tool 400 is in the second position. When firstsurgical tool 400 is in the second position and rotated in a firstdirection (clockwise direction) the outside circumferential surface 456translates only the first set screw 252 thereby causing only the firsttrolley 256 to move towards the proximal end 101 of spinal implant 100and allowing the second trolley 258 to remain stationary in place. Inturn, the first trolley 256 urges the proximal end 101 of top and bottomendplates 110, 120 thereby causing top and bottom endplates 110, 120 tomove apart from one another at the proximal end 101 in the directionshown by the arrows thereby increasing an angle of inclination betweenthe top and bottom endplates 110, 120. Likewise, when first surgicaltool 400 is in the second position and is rotated in the seconddirection (counter-clockwise direction) the outside circumferentialsurface 456 translates only the first set screw 252 thereby causing thefirst trolley 256 to move towards the stationary second trolley 258. Ineffect, the top and bottom endplates 110, 120 move towards one anotherat the proximal end 101 (not illustrated) thereby decreasing an angle ofinclination between the top and bottom endplates 110, 120. In summary,when positioning the first surgical tool 400 in the second position androtating the first surgical tool 400 in either the first or seconddirection the moving mechanism 250 operably adjusts an angle ofinclination between the top and bottom endplates 110, 120 upon rotatingthe first set screw along the rotation axis.

FIGS. 11A and 11B are perspective views of a moving mechanism 250 in acontracted position and an expanded position, respectively. Movingmechanism 250 is suitable for use in any exemplary embodiments disclosedherein. As illustrated moving mechanism 250 includes a screw guidehousing 105 a coupled to screw guide endplate 105 (not illustrated) anda central buttress block 257. Screw guide housing 105 a may operablyretain first and second screws 252, 254 therein and thereby define arotation axis of moving mechanism 250 projecting in a longitudinaldirection thereof. First and second trolleys 256, 258 are operablycoupled to first and second set screws 252, 254 and are furtherconfigured to move along outside surfaces of screw guide housing 105 aupon rotation of first and second set screws 252, 254.

First trolley 256 includes a first beveled edge 256 a and a secondbeveled edge 256 b opposite the first beveled edge 256 a, the first andsecond beveled edges 256 a, 256 b are disposed on opposite sides of therotation axis of the moving mechanism 250. Second trolley 258 includes athird beveled edge 258 a and a fourth beveled edge 258 b (notillustrated) opposite the third beveled edge 258 a, the third and fourthbeveled edges 258 a, 258 b are disposed on opposite sides of therotation axis of the moving mechanism 250. Additionally, first trolley256 has a first side surface and a second side surface opposite thefirst side surface, the first and second side surfaces being on oppositesides of the rotation axis of the moving mechanism 250. Likewise, secondtrolley 256 has a third side surface and a fourth side surface oppositethe third side surface, the third and fourth side surfaces being onopposite sides of the rotation axis of the moving mechanism 250.Furthermore, buttress block 257 has a seventh and eighth side surfaceopposite the seventh side surface, the seventh and eighth side surfacesbeing on opposite sides of the rotation axis of the moving mechanism250.

First trolley 256 includes a first plurality of projections 256 c, thesecond trolley 258 includes a second plurality of projections 258 c, andthe buttress block 257 includes a third plurality of projections 257 c.In the exemplary embodiment, first trolley 256 has two projections 256 cprojecting perpendicularly out from first side surface and twoprojections 256 c projecting perpendicularly out from second sidesurface. Likewise, second trolley 258 has two projections 258 cprojecting perpendicularly out from third side surface and twoprojections 258 c projecting perpendicularly out from fourth side.Furthermore, buttress block 257 has two projections 257 c projectingperpendicularly out from seventh side surface and two projections 258 cprojecting perpendicularly out from eighth side surface. The first andsecond plurality of projections 256 c, 258 c may be conically shapedprojections having a dome like shape or a hemispherical shape, forexample. In the non-limiting exemplary embodiment, each projection ofthe first and second plurality of projections 256 c, 258 c comprises ahemispherical projection having a flat surface that coincides with acorresponding surface of one of the first through fourth beveled edges256 a, 256 b, 258 a, 258 b. However, other embodiments may have othershapes and/or surface profiles as may be consistent with the disclosureherein.

First trolley 256 includes a first plurality of wedges 256 d and secondtrolley 258 includes a second plurality of wedges 258 d. For example,first trolley 256 includes a first wedge 256 d projecting away from thefirst side surface in a transverse direction of the moving mechanism 250and a second wedge 256 d projecting away from the second side surface inthe transverse direction of the moving mechanism. Likewise, secondtrolley 258 includes a third wedge 258 d projecting away from the thirdside surface in a transverse direction of the moving mechanism 250 and afourth wedge 258 d projecting away from the fourth side surface in thetransverse direction of the moving mechanism. In the exemplaryembodiment, each wedge of the first plurality of wedges 256 d includes acorresponding upper contact surface 256 e and a corresponding lowercontact surface 256 f and each respective upper contact surface 256 emeets a corresponding lower contact surface 256 f at an apex point (notlabeled). Likewise each wedge of the second plurality of wedges 258 dincludes a corresponding upper contact surface 258 e and a correspondinglower contact surface 258 f and each respective upper contact surface258 e meets a corresponding lower contact surface 258 f at an apex point(not labeled). In the exemplary embodiment, each upper contact surface256 e, 258 e and each lower contact surface 256 f, 258 f has a curvedsurface profile. For example, each upper contact surface 256 e, 258 e isconcave with respect to a corresponding apex point and each lowercontact surface 256 f, 258 f is convex with respect to a correspondingapex point.

FIGS. 12A and 12B are perspective views of moving mechanism 250 of FIGS.11A and 11B in the contracted position and the expanded position,respectively, shown with an exemplary bottom endplate 120. FIGS. 13A and13B are perspective views of the moving mechanism 250 of FIGS. 12A and12B in the contracted position and the expanded position, respectively,with a top endplate 110 and a bottom endplate 120. It shall beunderstood that FIGS. 12A-13B schematically moving mechanism 250 withsome internal parts being illustrated or simplified and others beingomit for ease of explanation. For example, FIGS. 12A-13B are illustratedschematically solely to assist in explaining operable characteristics ofmoving mechanism 250. FIGS. 12A and 12B show bottom endplate 120 havinga pair of second proximal ramps 124 and a pair of second distal ramps126 disposed opposite the pair of second proximal ramps 124. Each rampof second proximal ramps 124 may include a first inclined contactsurface 124 a extending away from buttress block 257 and inclined withrespect to an inside surface 122 of endplate 120. Similarly, each rampof second distal ramps 126 may include a second inclined contact surface126 a extending away from buttress block 257 and inclined with respectto an inside surface 122 of endplate 120. In the exemplary embodiment,the first inclined contact surfaces extend a first length (firstdistance) and the second inclined contact surfaces extend a secondlength (second distance) and the first length is greater than the secondlength.

FIGS. 13A and 13B show top endplate 110 having a pair of first proximalramps 114 and a pair of first distal ramps 116 disposed opposite thepair of first proximal ramps 114. Each ramp of first proximal ramps 114may include a third inclined contact surface 114 a extending away frombuttress block 257 and inclined with respect to an inside surface 112 ofendplate 110. Similarly, each ramp of first distal ramps 116 may includea fourth inclined contact surface 116 a extending away from buttressblock 257 and inclined with respect to an inside surface 112 of endplate110. In the exemplary embodiment, the third inclined contact surfacesextend a third length (third distance) and the fourth inclined contactsurfaces extend a fourth length (fourth distance) and the third lengthis greater than the fourth length.

Each ramp of ramps 114, 116, 124, 126 may have an inside surfacedisposed adjacent to and facing the rotation axis of moving mechanism250 and an outside surface opposite the inside surface and facing awayfrom the rotation axis of moving mechanism 250. Additionally, each rampof ramps 114, 116, 124, 126 may include a corresponding guide wall 130,which is best illustrated in FIGS. 12A and 17 . Each guide wall 130 mayextend along the inside surface of a corresponding ramp in a paralleldirection to the corresponding contact surface. For example, withreference to FIGS. 12A-13B, guide wall 130 extends along the insidesurface of proximal ramp 124 in a direction that is substantiallyparallel to first inclined contact surface 124 a. As best understoodwith reference to FIGS. 12A-12B, each bottom most projection 256 c ofthe first trolley 256 is disposed inside of a corresponding guide wall130 of the second proximal ramps 124. Likewise, each bottom mostprojection 258 c of the second trolley 258 is disposed inside of acorresponding guide wall 130 of the second distal ramps 126. Similarly,although not directly visible, in FIGS. 13A-13B each top most projection256 c of the first trolley 256 is disposed inside of a correspondingguide wall 130 of first proximal ramps 114. Likewise, each top mostprojection 258 c of second trolley 258 is disposed inside of acorresponding guide wall 130 of first distal ramps 116.

With reference to FIGS. 13A and 13B, when first surgical tool 400 is inthe first position and translates first and second screws 252, 254 inthe first direction the first and second trolleys 256, 258 move awayfrom one another in opposite directions and the top endplate 110 andbottom endplate 120 move away from one another as the spinal implant 100expands. For example, in some embodiments, beveled edges 256 a, 256 b ofthe first trolley 256 act against endplates 110, 120 at a proximal end101 thereof and the first plurality of wedges 256 d contact and slidealong a corresponding ramp of the first and second first proximal ramps114, 124. However, in other embodiments, 256 e and 256 f may act againstinclined contact surface 124 a in lieu of providing beveled edges 256 a,256 b. In some embodiments, beveled edges 258 a, 258 b of the secondtrolley 258 act against endplates 110, 120 at a distal end 102 thereofand the second plurality of wedges 258 d contact and slide along acorresponding ramp of the first and second first distal ramps 116, 126.However, in other embodiments, 258 e and 258 f may push against inclinedcontact surface 126 a in lieu of providing beveled edges 256 a, 256 b.Additionally, each projection 256 c of the first trolley 256 slidesalong a corresponding guide wall 130 of the first and second firstproximal ramps 114, 124 and each projection 258 c of the second trolley258 slides along a corresponding guide wall 130 of the first and seconddistal ramps 116, 126. Furthermore, during the expansion of spinalimplant 100 each projection 257 c of buttress block 257 may slidevertically in a corresponding vertical guide wall 130 a (see FIG. 17 )of the top and bottom endplates 110, 120. In this way, the spinalimplant 100 moves from a contracted position to an expanded position. Itshall be understood that movement of spinal implant from the expandedposition to the contracted position occurs in substantially the sameway.

When first surgical tool 400 is in the second position and translatesonly the first screw 252 in the first direction the first trolley 256moves away from buttress block 257 and stationary second trolley 258 andan angle of inclination between the top endplate 110 and bottom endplate120 increases. For example, beveled edges 256 c of first trolley 256 maypush against endplates 110, 120 at a proximal end 101 thereof and/or thefirst plurality of wedges 256 d may contact and slide along acorresponding ramp of the first and second first proximal ramps 114, 124as explained above. Additionally, each projection 256 c of the firsttrolley 256 slides along a corresponding guide wall 130 of the first andsecond first proximal ramps 114, 124 as explained above. The secondtrolley 258 remains stationary with beveled edges 258 a, 258 b remainingin contact with endplates 110, 120 at a distal end 102 thereof and thesecond plurality of wedges 258 d remaining in contact with acorresponding ramp of the first and second distal ramps 116, 126. Due tofirst trolley 256 acting against endplates 110, 120 by moving away frombuttress block 127 and second trolley 258 remaining stationary thesecond plurality of wedges 258 d pivot along a corresponding ramp of thefirst and second distal ramps 116, 126 and each projection 258 c of thesecond trolley 258 pivots and/or incrementally slides along acorresponding guide wall 130 of the first and second first distal ramps116, 126. Furthermore, during the expansion of spinal implant 100 eachprojection 257 c of buttress block 257 may slide vertically up and downin a corresponding vertical guide wall 130 a (see FIG. 17 ) of the topand bottom endplates 110, 120 as necessary. In this way, a distancebetween endplates 110, 120 at the proximal end 101 is increased and adistance between endplates 110, 120 at the distal end 102 is minutelydecreased thereby adjusting an angle of inclination between top endplate110 and bottom endplate 120. Those with skill in the art, willappreciate that in disclosed exemplary embodiments first set screw 252is longer than second set screw 254 thereby providing more room fortravel of the first trolley 256 such that the first trolley 256 mayenable a greater distance of travel between endplates 110, 120 at theproximal end 101 than second trolley 258 enables at the distal end 102.

FIGS. 14A and 14B are cut-out views of a moving mechanism 250 inrelation to a top endplate 110. As shown, moving mechanism 250 includesa rotation axis R₁ projecting in a longitudinal direction thereof andextending in a transverse direction of endplate 110 (from proximal side101 to distal side 102). Rotation axis R₁ projects through the center ofset screws 252, 254. Moving mechanism 250 includes a transverse axis T₁intersecting a center of rotation axis and projecting perpendicular torotation axis R₁ through buttress block 257.

FIG. 15 illustrates a cross section of moving mechanism 250 taken alongrotation axis R₁. As shown, first set screw 252 is operably coupled withfirst trolley 256 by a plurality of keyed projections 256 k (threadpattern) that correspond to the pitch pattern of first set screw 252.Second set screw 254 is operably coupled with second trolley 258 by aplurality of keyed projections 258 k (thread pattern). First set screw252 includes a first internal circumferential surface 252 a and secondset screw 254 includes a second internal circumferential surface. Thebuttress block 257 includes an interior retention cavity 257 b where afirst retaining portion 252 r of first set screw 252 and a secondretaining portion 254 r of second set screw 254 are retained. Interiorretention cavity 257 b may be an internal cavity spanning the insidecircumference of buttress block 257 and configured to enable first setscrew 252 and second set screw 254 to freely rotate along the rotationaxis R₁ while preventing first set screw 252 and second set screw 254from traveling in the longitudinal direction of moving mechanism 250.

FIG. 16 is a perspective view of a top endplate 110 and bottom endplate120 of spinal implant 100 and FIG. 17 is an exploded view of the topendplate 110 and bottom endplate 120 of FIG. 16 . In the exemplaryembodiment, when spinal implant 100 is in the closed position, insidesurface 112 of top endplate 110 and inside surface 124 of bottomendplate 120 are nested or partially nested with respect to one another.For example, FIG. 16 shows first proximal ramps 114 of top endplate 110inset from second proximal ramps 124 of bottom endplate 120.Additionally, top endplate 110 includes a first plurality of recesses110 n that allow corresponding components of bottom endplate 120 a tonest inside of when spinal implant 100 is in the contracted position.For example, FIG. 16 shows second proximal ramps 124 nested inside ofrecess 110 n. In some embodiments, recesses 110 n may be referred to asnested recesses for convenience in explanation.

Top endplate 110 and/or bottom endplate 120 may optionally include atleast one anchoring aperture 129. In the exemplary embodiment, topendplate 110 includes a pair of top anchoring apertures 129 a, 129 b,that pass through top endplate 110 at an inclined angle with respect tooutside surface 111 of top endplate 110. Similarly, bottom endplate 120includes a pair of bottom anchoring apertures 129 c, 129 d that passthrough bottom endplate 120 at an inclined angle with respect to outsidesurface 121 of endplate 120. Each anchoring aperture 129 of theplurality of anchoring apertures 129 a-129 d is disposed adjacent anoutside surface of a corresponding ramp 114, 116 however exemplaryembodiments are not limited to the specific location shown in FIG. 17 .

FIGS. 18A-18B are perspective views of a first surgical tool 400 of anadjustable spinal implant system in accordance with the principles ofthe present disclosure. FIGS. 19A-19B are side views of the firstsurgical tool 400 and a corresponding adjustment rod 450 configured forinsertion inside of first surgical tool 400. Tip 406 is configured toconnect to spinal implant 100 such that spinal implant 100 is securelyattached to first surgical tool 400 by engaging locking mechanism 408.Similarly, tip 406 is configured to disconnect from spinal implant 100such that spinal implant 100 is no longer securely attached to firstsurgical tool 400 by disengaging locking mechanism 408. For example,FIG. 19A shows tip 406 in a first locking position with tip grips 406 abeing expanded for gripping onto spinal implant 100 and FIG. 19B showstip 406 in a second locking position with tip grips 406 a beingretracted. Locking mechanism 408 is configured to toggle between thefirst locking position and second locking position. In some embodiments,when locking mechanism 408 is engaged in the first locking positionspinal implant 100 is fixedly coupled to first surgical tool 400 suchthat it will not rotate. This may be advantageous for initialpositioning of spinal implant 100 between vertebral bodies duringsurgery. Additionally, first surgical tool 400 includes a positioningmechanism 410 configured to position adjustment rod 450 in a firstposition and a second position (see FIG. 19A). First surgical tool 400may also include a push button 420 to toggle between positioningadjustment rod 450 in a first position to engage both first and secondset screws 252, 254 and a second position to engage only the first setscrew 252 (see FIG. 18B). Furthermore, in some embodiments firstsurgical tool 400 may include a window 421 to identify whether bothfirst and second set screws 252 254 are engaged for parallelexpansion/contraction of spinal implant 100 or whether only the firstset screw 252 is engaged for adjusting an angle of inclination of spinalimplant 100.

In the exemplary embodiment, first surgical tool 400 includes a centralshaft aperture 409 extending through handle 402, shaft 404, and tip 406.Central shaft aperture 409 is configured to receive adjustment rod 450therein such that adjustment knob 452 is rotatable therein andprotrudes, at least partly, from both ends. Adjustment rod 450 includesan adjustment knob 452, first and second positioning surfaces 453, 454and keyed circumferential surface 456. When adjustment rod 450 ispositioned within central shaft aperture 409, adjustment knob 452protrudes from one end and keyed circumferential surface 456 protrudesfrom the other end (see FIG. 14 ). With adjustment rod 450 insertedwithin central shaft aperture 409 positioning mechanism 410 can extendand retract adjustment rod 450 in the longitudinal direction of shaft409. As explained above with respect to FIGS. 13A and 13B, when firstsurgical tool 400 is in the first position, keyed circumferentialsurface 456 may rotate first and second set screws 252, 254 along therotation axis and when first surgical tool 400 is in the secondposition, keyed circumferential surface 456 may rotate only the firstset screw 252 along the rotation axis. In some embodiments, positioningmechanism 410 is configured to be toggled between a first position and asecond position where it can act against positioning surfaces 453, 454to extend and retract adjustment rod 450 in the longitudinal directionof shaft 409. For example, in the first position positioning mechanism410 may extend adjustment rod 450 from tip 406 to an extended positionwhere circumferential surface 456 may engage with internalcircumferential surfaces of the first and second set screws 252, 254. Inthe second position, positioning mechanism 410 may retract adjustmentrod 450 through tip 406 to a partially retracted position wherecircumferential surface 456 may only engage with internalcircumferential surface of the first set screw 252. An internal gearingof positioning mechanism 410 may include internal locking pins andsurfaces that act against positioning surfaces 453, 454 such that whenan exposed turn dial knob of positioning mechanism 410 is turned to aparticular position, the internal locking pins and surfaces act againstthe inclined and recessed surfaces of positioning surfaces 453, 454.

Additionally, in some embodiments, first surgical tool 400 may beconfigured to receive adjustment rods 450 of varying lengths havingvarying outside circumferential surfaces 456 and positioning surfaces453, 454. For example, first surgical tool 400 may be configured toreceive a first relatively shorter adjustment rod 450 optimized for usefor a spinal implant 100 using corresponding relatively smallerendplates 110, 120 of FIGS. 6A-7C and a corresponding smaller movingmechanism 250 having a relatively shorter longitudinal axis optimizedfor such relatively shorter endplates 110 x, 120 x. For example still,first surgical tool 400 may be configured to receive a second relativelylonger adjustment rod 450 optimized for use for a spinal implant 100using corresponding relatively larger endplates 110 z, 120 z of FIGS.6A-7C and a corresponding larger moving mechanism 250 having arelatively longer longitudinal axis optimized for such relatively longerendplates 110 z, 120 z.

Additionally, in some embodiments, first surgical tool 400 may beconfigured to receive multiple types of adjustment rods 450. In at leastone embodiment, first surgical tool 400 may receive a first adjustmentrod 450 with an outside circumferential surface 456 that is configuredto engage (1) both the first and second set screws 252, 254 at the sametime and (2) the first set screw 252. For example, the first adjustmentrod 450 may be toggled between (1) a first position where outsidecircumferential surface 456 is fully extended and configured to engageboth the first and second set screws 252, 254, and (2) a second positionwhere outside circumferential surface 456 is partially extended (and/orpartially retracted) to engage only the first set screw 252. In analternate embodiment, first surgical tool 400 may receive a secondadjustment rod 450 with an outside circumferential surface 456 that isconfigured to engage only one set screw 252, 254 at a time. For example,the outside circumferential surface 456 may have an engagement surfacewith a longitudinal length that corresponds to a single set screw 252,254 such that it only engages with a single set screw 252, 254 at atime. For example, the second adjustment rod 450 may be toggled between(1) a first position where outside circumferential surface 456 is fullyextended and configured to engage the second set screw 254 independentlyof the first set screw 252 and (2) a second position where outsidecircumferential surface 456 is partially extended (and/or partiallyretracted) to engage only the first set screw 252. At least oneadvantage of having first surgical tool 400 being configured to receivemultiple types of adjustment rods 450 of varying lengths and havingoutside circumferential surfaces of different lengths is that a surgeoncan quickly and easily select the appropriate adjustment rod 450. Forexample, a surgeon may select first adjustment rod 450 toexpand/contract a spacing between endplates 110, 120 by the same orsubstantially the same amount while maintaining the angle of inclinationbetween endplates 110, 120, i.e., by engaging both first and second setscrews 252, 254. Additionally, a surgeon may select second adjustmentrod 450 to selectively increase/decrease an angle of inclination betweenendplates of spinal implant 100 at the proximate side 101 and the distalside 102 independently, i.e., by only engaging one of first and secondset screws 252, 254 at a time. For example still, the second adjustmentrod 450 may be configured to adjust spinal implant 100 to enableanterior expansion separately from enabling posterior expansion whichmay enable spinal implant 100 to be placed in kyphosis as is consistentwith above explained embodiments.

Furthermore, in some embodiments, first surgical tool 400 is configuredto operate in three modes. In the first mode, tip grips 406 a aresecurely connected to spinal implant 100. In the second mode, adjustmentrod 450 may be positioned in a first position such that upon selectiverotation of adjustment knob 452 a spacing between endplates 110, 120selectively increase/decrease in minute increments. For example, byrotating each of first set screw 252 and second set screw 254. In thethird mode, adjustment rod 450 may be positioned in a second positionsuch that upon selective rotation of adjustment knob 452 an angle ofinclination between endplates 110, 120 may selectively increase/decreasein minute increments. For example, by only rotating first set screw 252an angle of inclination between endplates 110, 120 may increase/decreaseby moving one side of the endplates 110,120 towards/away from each otherand moving the opposite side of the endplates 110,120 in an oppositedirection. In some embodiments, this may also happen by only rotatingsecond set screw 254. For example, first surgical tool 400 may have arelatively short circumferential engagement surface 456 that will onlyengage a single one of the internal circumferential surfaces of first orsecond set 252, 254 at a time.

FIG. 20 illustrates a perspective view of one embodiment of anexpandable spinal implant 100 including a plurality of anchoring screws510. In some embodiments, anchoring screws 510 may be referred to asbone screws. In the exemplary spinal implant 100, top endplate 110includes a first anchoring screw 510 a, and a second anchoring screw 510b opposite the first anchoring screw 510 a that each extend through acorresponding aperture. For example, first and second anchoring screws510 a, 510 b pass through a corresponding aperture of top endplate 110configured to orient them at an inclined angle with respect to outsidesurface 111 of top endplate 110. Similarly, bottom endplate 120 includesa third anchoring screw 510 c, and a fourth anchoring screw 510 d thateach extend through a corresponding aperture. Anchoring screws 510 c,510 d project from a proximal end 101 of spinal implant 100 at aninclined angle towards distal end 102. For example, third and fourthanchoring screws 510 c, 510 d pass through a corresponding aperture ofbottom endplate 120 configured to orient them at an inclined angle withrespect to outside surface 121 of bottom endplate 120. However, it shallbe understood that in other embodiments at least one aperture may orienta corresponding anchoring screw 510 a, 510 b, 510 c, 510 d at any anglewith respect to the corresponding endplate 110, 120 consistent with thedisclosure herein. Anchoring screws 510 a-510 d are configured to anchorinto corresponding adjacent vertebral bodies.

FIGS. 21A-21B illustrate a lateral side view and front side view,respectively, of one embodiment of an expandable spinal implant systemin which anchoring screws 510 a-510 d are anchored into adjacentvertebral bodies. As illustrated, anchoring screws 510 a, 510 b projectout from top endplate 110 of spinal implant 100 from a proximal end 101at an inclined angle towards distal end 102 thereby anchoring into a topvertebral body V₁. Similarly, anchoring screws 510 a, 510 b project outfrom bottom endplate 120 of spinal implant 100 from a proximal end 101at an inclined angle towards distal end 102 thereby anchoring into abottom vertebral body V₂. As used herein, a pair of vertebral bodies,adjacent vertebral bodies, and/or first and second vertebral bodies mayrefer to, e.g., top vertebral body V₁ and bottom vertebral body V₂.

FIG. 22A is a side view of a second surgical tool 500 suitable for usewith disclosed embodiments and systems herein, e.g., to drive anchoringscrews 510 a-510 d. FIG. 22B is a side view of an enlarged region ofFIG. 22A. Exemplary, second surgical tool 500 includes a ratchetingdrive shaft 555, a positioning handle 520, a tip portion 530, a driveshaft housing 540, and a trigger 550. Ratcheting drive shaft 555 may beconfigured to connect and disconnect with a ratcheting handle (notshown) and rotate within ratcheting drive shaft housing 540. Forexample, the drivable connection may comprise a variety of driveinterfaces including but not limited to: multi-lobular drives;hexalobular drives; cross or Phillips head drives; straight or “flathead” drives; square or other polygonal drives; and/or combinationsthereof. Positioning handle 520 may be configured to assist withmaintaining and controlling the second surgical tool 500, e.g., in viewof torque transmitted through ratcheting drive shaft 555. Tip portion530 is angled at a degree β with respect to a longitudinal direction ofdrive shaft housing 540. In some embodiments, tip portion 530 is angledsuch that the degree β corresponds to the inclination of anchoringscrews 510 a-510 d and the inclination of anchoring aperture 129. Forexample, anchoring apertures 129 may be inclined about 30°-50°, and moreparticularly about 40°, with respect to an outside surface 111, 121 ofendplates 110, 120. This arrangement may be advantageous for drivinganchoring screws 510 a-510 d while spinal implant 100 is positionedbetween adjacent vertebral bodies. Tip portion 530 may secure anchoringscrew 510 in an internal cavity therein such that anchoring screw 510may not disconnect during initial positioning of anchoring screw 510.For example, tip portion 530 may have a flexible elastic memberconfigured to securely retain a head portion of anchoring screw 510. Tipportion 530 may, however, release anchoring screw 510 when anchoringscrew is sufficiently anchored into an anatomical feature, such as avertebrae for example. This feature may be particularly advantageousduring surgery for maintaining the anchoring screw 510 in tip portion530 such that anchoring screw 510 does not uncouple from tip portion 530when initially positioning anchoring screw 510 in an anchoring aperture,for example anchoring aperture 129. Additionally, in some embodimentstip portion 530 is operably coupled with trigger 550 such that trigger550 may disconnect anchoring screw 510 when anchoring screw 510 isinstalled. In some embodiments, trigger 550 may not be necessary becausetip portion 530 may self-release anchoring screw 510 after installation.

FIGS. 23A-23C are various perspective views of exemplary anchoringscrews suitable for use with disclosed embodiments herein in conjunctionwith the second surgical tool 500. FIG. 23A shows a trocar tip anchoringscrew 510 e, FIG. 23B shows a flutes or fluted tip anchoring screw 510f, and FIG. 23C shows a speed anchoring screw 510 g. Each anchoringscrew 510 e-510 g may have a thread pitch and sizing that corresponds toa size of anchoring aperture 129. Trocar tip anchoring screw 510 eincludes an angled tip portion 510 e-1 and a thread pattern includingthreads 510 e-2. Threads 510 e-2 may be spaced back from angled tipportion 510 e-1 which may facilitate with aligning anchoring screw 510 ewith anchoring aperture 129. For example, in some embodiments, threads510 e-2 are spaced back about 3 mm from angled tip portion 510 e-1.Fluted tip anchoring screw 510 f includes a cutting tip 510 f-1 and athread pattern included threads 510 f-2. Cutting tip 510 f-1 may extenda relatively long distance from the beginning of threads 510 f-2 suchthat the cutting tip 510 f-1 may pre-drill into an adjacent vertebralbody before the threads 510 f-2 engage with anchoring aperture 129. Forexample, in some embodiments, threads 510 f-2 are spaced back about 8 mmfrom cutting tip 510 f-1. Speed anchoring screw 510 g includes a conicaltip 510 g-1 and a thread pattern including threads 510 g-2. Differentfrom trocar tip anchoring screw 510 e and fluted tip anchoring screw 510f, threads 510 g-2 of speed anchoring screw 510 g may begin immediatelyadjacent conical tip 510 g-1.

FIGS. 24A-24D are various side views and top down views of exemplarybone graft areas in accordance with the principles of the presentdisclosure. In the side view of FIG. 24A, first and second regions R₁,and R₂ are shown where bone growth material may be grafted and/or bonegrowth promoting materials may be used. In the top down view of FIG.24B, third and fourth regions R₃, R₄ are shown where bone growthmaterial may be grafted and/or bone growth promoting materials may beused. In some embodiments, third and fourth regions R₃, R₄ overlapvertically with first and second regions R₁, and R₂. In FIGS. 24C and24D an exemplary grafting section GS is shown. Grafting section GS maybe grafted to an endplate 110, 120. In some embodiments, graftingsection GS may be filled with a bone growth material having a resultantsurface area ranging from about 140 mm² to about 180 mm, and moreparticularly about 160 mm². For example, the bone growth material mayextend through the grafting section GS three dimensionally and have acorresponding surface area ranging from about 140 mm² to about 180 mm²,and more particularly about 160 mm². Consistent with disclosedembodiments herein, the open arrangement of spinal implant 100 andendplates 110, 120 in particular is advantageous for direct segmentalfusion techniques. For example, the superior and inferior vertebralendplates allow the creation of a fusion bone bridge to solidify asegment. Additionally, the expandable and contractible nature of spinalimplant 100 lends to bone packing techniques after positioning andadjusting spinal implant 100 between vertebral bodies. For example,after spinal implant 100 is positioned between adjacent vertebralbodies, spinal implant 100 may be packed with bone material in situ. Insome embodiments, the endplate 110 may be considered a direct superiorvertebral endplate and endplate 120 may be considered an inferiorvertebral endplate where such endplates are configured to allow for afusion bone bridge there through to solidify a segment.

In some embodiments, the spinal implant system includes an agent,including but not limited to the bone growth promoting materialsdescribed herein, which may be disposed, packed, coated or layeredwithin, on or about the components and/or surfaces of the spinal implantsystem. In some embodiments the bone growth promoting material may bepre-packed in the interior of spinal implant 100, and/or may be packedduring or after implantation of the implant via a tube, cannula, syringeor a combination of these or other access instruments. Additionally,bone growth promoting material may be further tamped into spinal implant100 before, during or after implantation. In some embodiments, the bonegrowth promoting material and/or directly grafted material may enhancefixation of spinal implant 100 with adjacent bony structures. In someembodiments, the agent may include one or a plurality of therapeuticagents and/or pharmacological agents for release, including sustainedrelease, to treat, for example, pain, inflammation and degeneration.

FIGS. 25A and 25B illustrate spin implant 100 in a first bent positionand a second bent position, respectively. FIG. 25A shows spinal implant100 where top endplate 110 is bent in a first lateral direction withrespect to bottom endplate 120. FIG. 25B shows spinal implant 100 wheretop endplate 110 is bent in a second lateral direction, opposite thefirst lateral direction, with respect to bottom endplate 120. Asexplained in greater detail above, the various disclosed projections,guide walls, cavities, recesses, etc. are configured such that spinalimplant 100 may allow for lateral bending to some predetermined degree.For example, projections 256 c, 257 c, 258 c may pivot laterally inguide walls 130 to accommodate some degree of lateral bending. In thisway, top endplate 110 and bottom endplate 120 may be configured tolaterally bend with respect one another in a first direction and asecond direction by a predetermined amount. However, in otherembodiments it may be desirable for spinal implant 100 to be rigid inthe lateral direction and for no lateral bending to be permissible.

FIGS. 26-28 illustrate a left side view, right side view, and front sideview, respectively, of an installed expandable spinal implant 100positioned between adjacent vertebral bodies according to varioussurgical techniques, e.g., anterior techniques, oblique techniques,lateral techniques. For example, FIGS. 26-28 show spinal implant 100after being installed according to an anterior lumbar interbody fusion(ALIF) technique.

Spinal implant systems of the present disclosure can be employed with asurgical arthrodesis procedure, such as, for example, an interbodyfusion for treatment of an applicable condition or injury of an affectedsection of a spinal column and adjacent areas within a body, such as,for example, intervertebral disc space between adjacent vertebrae, andwith additional surgical procedures and methods. In some embodiments,spinal implant systems can include an intervertebral implant that can beinserted between adjacent vertebral bodies to space apart articularjoint surfaces, provide support for and maximize stabilization ofvertebrae. In some embodiments, spinal implant systems may be employedwith one or a plurality of vertebra.

Consistent with the disclosed embodiments herein, a medical practitionermay obtain access to a surgical site including vertebrae such as throughincision and retraction of tissues. Spinal implant systems of thepresent disclosure can be used in any existing surgical method ortechnique including open surgery, mini-open surgery, minimally invasivesurgery and percutaneous surgical implantation, whereby vertebrae areaccessed through a mini-incision, retractor, tube or sleeve thatprovides a protected passageway to the area, including, for example, anexpandable retractor wherein the sleeve is formed from multiple portionsthat may be moved apart or together and may be inserted with theportions closed or together and then expanded to allow for insertion ofimplants of larger size than the closed cross section of the unexpandedretractor portions. In one embodiment, the components of the spinalimplant system are delivered through a surgical pathway to the surgicalsite along a surgical approach into intervertebral disc space betweenvertebrae. Various surgical approaches and pathways may be used.

As will be appreciated by one of skill in the art, a preparationinstrument (not shown) may be employed to remove disc tissue, fluids,adjacent tissues and/or bone, and scrape and/or remove tissue fromendplate surfaces of a first vertebra and/or endplate surface of asecond vertebra in preparation for or as part of the proceduresutilizing a system of the present disclosure. In some embodiments, thefootprint of spinal implant 100 is selected after trialing usingtrialing instruments (not shown) that may approximate the size andconfiguration of spinal implant 100. In some embodiments, such trialsmay be fixed in size and/or be fitted with moving mechanisms 250 similarto embodiments described herein. In some embodiments, spinal implant 100may be visualized by fluoroscopy and oriented before introduction intointervertebral disc space. Furthermore, first and second surgical tools400, 500, and spinal implant 100 may be fitted with fiducial markers toenable image guided surgical navigation to be used prior to and/orduring a procedure.

Components of a spinal implant systems of the present disclosure can bedelivered or implanted as a pre-assembled device or can be assembled insitu. In one embodiment, spinal implant 100 is made of a single piececonstruction that may not be disassembled without destroying the device.In other embodiments, spinal implant 100 may comprise removable parts.Components of spinal implant system including implant 10, 20, 30 may beexpanded, contracted, completely or partially revised, removed orreplaced in situ. In some embodiments, spinal implant 100 can bedelivered to the surgical site via mechanical manipulation and/or a freehand technique.

Additionally, components of spinal implant 100 can include radiolucentmaterials, e.g., polymers. Radiopaque markers may be included foridentification under x-ray, fluoroscopy, CT or other imaging techniques.Furthermore, first and second surgical tools 400, 500 may be radiolucentand may optionally include markers added at a tip portion thereof topermit them to be seen on fluoroscopy/x-ray while advancing into thepatient. At least one advantage to having spinal implant 100 is that amedical practitioner can verify the positioning of spinal implant 100relative to adjacent vertebral bodies and make further adjustments tothe spacing between endplates 110, 120, angle of inclination betweenendplates 110, 120, and the overall positioning of the device within apatient's body. In this way, spinal implant 100 may correct alignment ofa patient's spine in a sagittal plane.

FIG. 29A is a perspective view of a second embodiment of an expandablespinal implant 200 in accordance with the principles of the presentdisclosure. Aspects of second spinal implant 100 may be the same as,substantially the same as, or similar to spinal implant 100.Additionally, second spinal implant 200 may be used in previouslydisclosed systems and methods. Accordingly, duplicative descriptionthereof will be omitted.

FIG. 29B is an exploded view illustrating second spinal implant 200.Second spinal implant 200 a top endplate 110 (first endplate) and abottom endplate 120 (second endplate) and a moving mechanism 2500, whichwill be described in greater detail below. The proximal end 101 includesa screw guide endplate 1050 disposed between endplates 110 and 120. Insome embodiments, screw guide endplate 1050 may be pivotable left-rightand up-down to accommodate insertion of first surgical tool 400 from anoff angle position. For example, screw guide endplate 1050 mayaccommodate a surgical tool that is insert off angle (not axiallyaligned) in a range of about 1° to 20°, and more particularly about 1°to 15° in the horizontal and vertical directions. At least one advantageof this arrangement is that first surgical tool 400 may be inserted offangle with respect to guide aperture 107 of spinal implant 200.

In the exemplary embodiment, moving mechanism 2500 is operably coupledto top endplate 110 and bottom endplate 120 similarly as explainedabove. Moving mechanism 2500 differs from moving mechanism 250 in thatmoving mechanism 2500 may be miss aligned, for example by about 5°, 10°,15°, or 20° when compared to moving mechanism 250 of the firstembodiment. In at least one embodiment, moving mechanism 2500 ismisaligned about 15° to facilitate insertion and posterior adjustment byreconnection posteriorly. In the exemplary embodiment, moving mechanism2500 operates by the same principles as moving mechanism 250 althoughthe interior contours of top endplate 110 and bottom endplate 120 areshifted to allow moving mechanism 2500 to be miss aligned.

FIG. 30A is a top down view of spinal implant 200 contrasting anembodiment where moving mechanism 2500 is miss aligned. As illustrated,spinal implant 200 has a first reference axis B₁ and a second referenceaxis B₂. First reference axis B₁ may be understood as a projection wheremoving mechanism 2500 is not miss aligned and where moving mechanism2500 is in a centered position. Second reference axis B₂ may beunderstood as a projection passing through a central portion of guideaperture 107 through moving mechanism 2500 when moving mechanism 2500 ismiss aligned inside of endplates 110, 120 to an off-centered position.

Referring generally to FIGS. 30B-30F, a modified embodiment of spinalimplant 200 where moving mechanism 2500 is miss aligned is disclosed. Inthe disclosed embodiment, moving mechanism 2500 features the same partsas moving mechanism 250 and operates under the same principles asexplained previously. In the disclosed embodiment, moving mechanism 2500is miss aligned by about 15° when compared with moving mechanism 250 ofspinal implant 100. In other embodiments, moving mechanism 2500 may bemiss aligned within any suitable range, e.g., from about 5° to 25°. FIG.30C is a perspective view of the embodiment of FIG. 30B with a topendplate 110 removed for ease of understanding. As illustrated, movingmechanism 2500 is misaligned and the top and bottom endplates 110, 120have a different geometry to accommodate the miss aligned movingmechanism 2500. Top and bottom endplates 110, 120 may feature the sameor substantially the same characteristics as previously disclosed. FIG.30D is an alternate perspective view of the embodiment of FIG. 30B witha top endplate 110 removed for ease of understanding. FIG. 30E is a topdown view of an exemplary top endplate 110 for use with the embodimentof FIG. 30B and FIG. 30F is a top down view of an exemplary bottomendplate 120 for use with the embodiment of FIG. 30B.

FIG. 31 is a perspective view of spinal implant 200 in an installedposition between vertebral bodies and three alternate positions of firstsurgical tool 400. FIG. 31 shows how first surgical tool 400 may beinserted into guide aperture 107 off angle with respect to firstreference axis B₁. Reference ring RR represents the extent of viableoffset positions that first surgical tool 400 may be operably insertedin guide aperture 107. In some embodiments, first surgical tool 400 maybe bent at a midsection area at 15° to enable a surgeon to adjust spinalimplant 200 in such a way as to avoid anatomical features and organs,such as, for example the pelvic ring and iliac crest. Additionally, thisadvantage is further expanded upon when using a miss-aligned movingmechanism 2500 that is miss aligned by, for example, about 15°.Therefore, disclosed systems of spinal implant 200 are able to bemanipulated by a surgeon via surgical tool 400 at the combined totalangular extent the moving mechanism 2500 is offset and the angularextent the surgical tool is bent. In at least one embodiment, the totalangular extent is about 30° on account of the moving mechanism 2500being offset about 15° and the surgical tool 400 being bent about 15°.

FIG. 32A is a top down view of a third embodiment of an expandablespinal implant 300 in accordance with the principles of the presentdisclosure. FIG. 32B shows spinal implant 300 in a perspective view.Aspects of spinal implant 300 may be the same as, substantially the sameas, or similar to spinal implant 100. Additionally, spinal implant 300may be used in previously disclosed systems and methods. Accordingly,duplicative description thereof will be omitted.

In some embodiments, the sizing and orientation of top and bottomendplates 110, 120 and the sizing and orientation of moving mechanism250 d is particularly advantageous for lateral insertion techniques.Spinal implant 300 includes a first reference axis C₁ and a secondreference axis C₂. Different than previous embodiments, first referenceaxis C₁ may span a longitudinal length of spinal implant 300 and passdirectly through a rotation axis of moving mechanism 250 d. Secondreference axis C₂ may bisect spinal implant 300 transversely across thecenter thereof. Additionally, second reference axis C₂ may intersectfirst reference axis C₁ and project through a center of buttress block257.

Spinal implant 300 may include a top endplate 110 d and a bottomendplate 120 d and a moving mechanism 250, which may be the same as orsubstantially the same as described above. Spinal implant 300 includes aproximal end 101 and a distal end 102 opposite the proximal end 101, anda first lateral end 103 and a second lateral end 104 opposite the firstlateral end 103. The first and second lateral ends 103, 104 extendbetween the proximal end 101 and the distal end 102. The proximal end101 includes an exposed screw guide endplate 105 defining acorresponding screw guide aperture 107, which are disposed betweenendplates 110 d and 120 d. The screw guide endplate 105 and guideaperture 107 may be the same as or substantially the same as describedabove.

Top endplate 110 may include a first outside surface 111 d and a firstinside surface 112 d opposite the first outside surface 111 d.Similarly, bottom endplate 120 d may include a second outside surface121 d and a second inside surface 122 d. The outside surfaces 111 d, 121d may be configured to be positioned between and/or contact vertebralbodies in a patients spine and have various surface characteristicssimilar to those described above with reference to spinal implant 100.In some embodiments, outside surfaces 111 d and 122 d may have asubstantially linear surface profile across faces of textured surfacesthereof. In other embodiments, outside surfaces 111 d and 122 d may havecurved surface profiles across faces of textured surfaces thereof.Further details of endplates 110 d, 120 d will be described in greaterdetail below.

Inside surfaces 111 d, 122 d, may surround moving mechanism 250 and havevarious contours, guides, cavities, and other operable characteristicsthat facilitate movement and/or provide mechanical advantage to otheroperable and movable corresponding parts to facilitate contraction,angular adjustment, lateral bending, absorption of compression forces,shear forces, etc. as will be explained in greater detail below.

In the exemplary embodiment, top endplate 110 d includes a pair of firstproximal ramps 114 d and a pair of first distal ramps 116 d opposite thefirst proximal ramps 114 d. Each ramp of the first proximal ramps 114 dincludes an inclined surface extending away from inside surface 112 dand moving mechanism 250 d. Similarly, each ramp of first distal ramps116 d includes an inclined surface extending away from inside surface112 d and moving mechanism 250 d. Bottom endplate 120 d includes a pairof second proximal ramps 124 d and a pair of second distal ramps 126 dopposite the second proximal ramps 124 d. Each ramp of the secondproximal ramps 124 d includes an inclined surface extending away frominside surface 122 d and moving mechanism 250 d. Similarly, each ramp ofsecond distal ramps 126 d includes an inclined surface extending awayfrom inside surface 11 d 1 and moving mechanism 250 d.

Exemplary spinal implant 300 includes a moving mechanism 250 d that isoperably coupled to top endplate 110 d and bottom endplate 120 d,similarly as explained above with reference to spinal implant 100.Accordingly, duplicative description will not be repeated. A firstfunctional feature of moving mechanism 250 d is that it is furtherconfigured to increase and decrease a spacing between the top and bottomendplates 110 d, 120 d upon simultaneous rotation of first and secondset screws 252, 254 in a clockwise and counterclockwise direction,respectively. A second functional feature of moving mechanism 250 d isthat it is further configured to increase and decrease an angle ofinclination between top and bottom endplates 110 d, 120 d upon rotationof the first set screw 252 in a clockwise and counterclockwisedirection, respectively.

FIG. 33A is a perspective view of spinal implant 300 in a contractedposition and FIG. 33B is a perspective view of spinal implant 300 in anexpanded position. In the contracted position of FIG. 33A, top endplate110 d and bottom endplate 120 d are contracted to a fully closedposition. In the expanded position of FIG. 33B, top endplate 110 d andbottom endplate 120 d are expanded an equal amount. Similarly asexplained above with reference to spinal implant 100 and FIGS. 9A-9Bwhen first surgical tool 400 is inserted in guide aperture 107 in afirst position and rotated in a first direction (clockwise direction)the first and second trolleys 256, 258 move away from one another anequal amount in opposite directions. In turn, the first and secondtrolleys 256, 258 cause the top and bottom endplates 110 d, 120 d tomove apart from one another an equal amount. Likewise, when firstsurgical tool 400 is rotated in a second direction (counter-clockwisedirection) first and second trolleys 256, 258 cause the top and bottomendplates 110 d, 120 d to move towards one another an equal amount in acontraction direction (not illustrated). In summary, when positioningthe first surgical tool 400 in the first position and rotating the firstsurgical tool 400 in either the first or second direction the movingmechanism 250 d operably adjusts a spacing between the top and bottomendplates 110 d, 120 d. FIG. 33C is a perspective view of spinal implant300 in a first angled position and FIG. 33D is a perspective view ofspinal implant 300 in a second angled position. Spinal implant 300 mayhave the same or similar features as explained above with respect tospinal implants 100, 200. Spinal implant 300 may be capable of (1)expanding/contracting the proximal end while the distal end remainsstationary, (2) expanding/contracting the distal end while the proximalend remains stationary, and (3) expanding/contracting both the proximalend and distal end simultaneously. Similarly as explained above withreference to spinal implant 100 and FIGS. 10A-10B when first surgicaltool 400 is inserted in guide aperture 107 in a second position, androtated in a first direction (clockwise direction) the first trolley 256moves away from the proximal end 101 of spinal implant 100 and thesecond trolley 258 remains stationary in place. In effect, the top andbottom endplates 110 d, 120 d move towards one another at the distal end102 (not shown) and move away from one another at the proximal end 101thereby decreasing an angle of inclination between the top and bottomendplates 110, 120.

Likewise, when first surgical tool 400 is in the second position and isrotated in the second direction (counter-clockwise direction) the firsttrolley 256 moves towards the stationary second trolley 258. In effect,the top and bottom endplates 110 d, 120 d move towards one another atthe proximal end 101 (not shown) thereby decreasing an angle ofinclination between the top and bottom endplates 110 d, 120 d. Insummary, when positioning the first surgical tool 400 in the secondposition and rotating the first surgical tool 400 in either the first orsecond direction the moving mechanism 250 operably adjusts an angle ofinclination between the top and bottom endplates 110, 120 upon rotatingthe first set screw along the rotation axis.

In the contracted position of FIG. 33A, a first height between topendplate 110 d and bottom endplate 120 d on the proximal side 101 anddistal side 102 is about 9 mm. In the first expanded position of FIG.33B, a second height of spinal implant 300 between top endplate 110 dand bottom endplate 120 d on the proximal side 101 and distal side 102is about 9 mm. Additionally, in the first expanded position of FIG. 33B,top endplate 110 d is parallel with respect to bottom endplate 110 d. Inthe first angled position of FIG. 33C, the top and bottom endplates 110d, 120 d are contacting each other at the distal side 102 and are spacedapart from one another at the proximal side 101. For example, at thedistal side 102, the height between top endplate 110 d and bottomendplate 120 d is about 9 mm. For example still, at the proximate side101, the height between top endplate 110 d and bottom endplate 120 d isabout 16 mm. Accordingly, an angle of inclination between top endplate110 d and bottom endplate 120 d at the distal side 101 is about 11°. Inthe second angled position of FIG. 33D, the top and bottom endplates 110d, 120 d are contacting each other at the proximal side 102 and arespaced apart from one another at the distal side 101. For example, atthe proximal side 102, the height between top endplate 110 d and bottomendplate 120 d is about 9 mm. For example still, at the distal side 101,the height between top endplate 110 d and bottom endplate 120 d is about16 mm. Accordingly, an angle of inclination between top endplate 110 dand bottom endplate 120 d at the proximal side 101 is about 11°.

In some embodiments, spinal implant 300 may comprise a three positioninner drive shaft (not illustrated) complimentary to or in place ofcomponents of moving mechanism 250. The three position inner drive shaftmay enable the first and second set screws 252, 254 to be adjustedindependently from one another as well as enabling the first and secondset screws 252, 254 to be adjusted concurrently or simultaneously. Forexample, first surgical tool 400 may have a relatively shortcircumferential surface 456 that will only engage one of the internalcircumferential surfaces of first or second set screws 252, 254 at atime. For example still, another first surgical tool 400 having arelatively longer circumferential surface 456 may engage both of theinternal circumferential surfaces of the first and second set screws252, 254 at the same time. Consistent with disclosed embodiments, asurgeon can use a first surgical tool 400 having a relatively shortercircumferential surface 456 to perform angular adjustments of spinalimplant 300 and then use a first surgical tool 400 having a relativelylonger circumferential surface 456 to perform height adjustments ofspinal implant 300. In other embodiments, spinal implant 300 may includea screw guide aperture 107 on both sides of the spinal implant 300thereby providing access to the first set screw 252 independently fromsecond set screw 254.

FIG. 34 is a perspective view of a spinal implant system utilizingspinal implant 300 and first surgical tool 400. In the exemplary system,spinal implant 300 is positioned in an installed position betweenvertebral bodies by first surgical tool 400 according to lateralinsertion techniques as explained in greater detail above. Firstsurgical tool 400 may operably adjust spinal implant 300 in situ betweenvertebral bodies as explained in greater above. For example, firstsurgical tool 400 may operably expand spinal implant 300 at a proximalside 101 and/or a distal side 102 thereof. In this way, spinal implant300 may correct alignment of a patient's spine in a coronal plane.

FIG. 35 is a perspective view of a spinal implant system utilizingspinal implant 300 highlighting how first surgical tool 400 maymanipulate spinal implant 300 from various angles. For example, spinalimplant 300 may include the same, substantially the same, or similarcomponents to moving mechanism 2500 as explained above. In the exemplaryembodiment, first surgical tool 400 may be inserted into guide aperture107 off angle with respect to first reference axis B 1. Reference ringRR represents the extent of viable offset positions that first surgicaltool 400 may be operably inserted in guide aperture 107. In someembodiments, first surgical tool 400 may be bent at a midsection area at15° (not illustrated) to enable a surgeon to adjust spinal implant 300in such a way as to avoid anatomical features and organs, such as, forexample the pelvic ring and iliac crest.

Referring generally to FIGS. 36-39B an additional expandable spinalimplant 600 is disclosed. Expandable spinal implant 600 may have thesame, substantially the same, and/or similar components and attributesas spinal implants 100, 200, and 300 including general applicabilitywith other relevant systems and surgical tools disclosed hereinabove.Spinal implant 600 may include a screw guide endplate 6150 having atleast one aperture 610 configured to receive an anchoring screw 510therein. Screw guide endplate 6150 may be relatively longer in lengththan screw guide endplate 150 discussed above and screw guide endplate6150 may be operably coupled with moving mechanism 250 similarly asexplained above with respect to spinal implants 100, 200, and 300.

In the illustrated embodiment, top endplate 110 and bottom endplate 120may each have an accommodating portion 630 having a corresponding sizeand geometry to the end portions of screw guide endplate 6150 such thatwhen spinal implant 600 is in the fully collapsed position the endportions of screw guide endplate 6150 will not increase a relativeheight of implant 600 in a fully collapsed position. For example,endplates 110, 120 may fully close without being impacted by screw guideendplate 6150 and therefore maintain a relatively compact size.

FIGS. 38A and 38B illustrate a front perspective view and a rearperspective view of an exemplary screw guide endplate 6150 having atleast one aperture 610 configured to receive an anchoring screw 510therein. In the illustrated embodiment, two apertures 610 are shownalthough embodiments in accordance with the principles of thisdisclosure may have any number of apertures 610. As illustrated, eachaperture 610 may be configured to selectively receive a correspondinganchoring screw therein. The outside entrance to each aperture 610 maydefine two alternate guided paths. For example, a first guided path maybe defined by the entrance to aperture 610 and a first exit aperture 610a and a second guided path may be defined by the entrance to aperture610 and a second exit aperture 610 b. In this way aperture 610 may beconfigured to orient one corresponding anchoring screw 510 at a time ineither of a first orientation or a second orientation.

Corresponding exemplary first and second orientations are illustrated inFIG. 37 which shows a first anchoring screw 510 (right anchoring screw)oriented upward at an inclined angle with respect to top endplate 110and a second anchoring screw 510 (left anchoring screw) orienteddownward at an inclined angle with respect to bottom endplate 120.Additionally, the first orientation may align a corresponding anchoringscrew 510 such that it projects through a corresponding slotted aperture640 of the first endplate 110 (see FIGS. 36 and 39A). Similarly, thesecond orientation may align a corresponding anchoring screw 510 suchthat it projects through a corresponding slotted aperture 640 of thesecond endplate 120 (see FIGS. 36 and 39B).

At least one advantage of the disclosed spinal implant 600 is that screwguide endplate 6150 and moving mechanism 250 may be configured such thatthe moving mechanism 250 can selectively adjust a spacing between thefirst and second endplates 110, 120 and adjust an angle of inclinationbetween the first and second endplates while the at least onecorresponding anchoring screw 510 is anchored within a correspondingvertebrae. For example, a surgeon may initially position spinal implant600 between adjacent vertebrae of a patient and install a correspondingfirst anchoring screw 510 in a first orientation projecting throughslotted aperture 640 of first endplate 110 and a corresponding secondanchoring screw 510 in a second orientation projecting through slottedaperture 640 of second endplate 120. Next, the surgeon may continue toadjust the spacing and/or angle of inclination between endplates 110,120 until the endplates 110, 120 are in the desired position. This ispossible, at least partly, because the relative location of the screwguide endplate 6150 remains fixed due to the anchored anchoring screws510 and the first and second endplates can freely expand/contract and/orincline/decline via moving mechanism 250 while anchoring screws 510extend through slotted aperture 640 (which has a geometry such that theanchored anchoring screws 510 do not interfere with the movement ofendplates 110, 120). For example, the endplates 110, 120 may freely movewhile anchoring screws 510 remain anchored in place in the correspondingvertebrae while also changing a relative positioning with respect to theslotted aperture 640 due to movement of endplates 110, 120.

Referring generally to FIGS. 40-44B an additional expandable spinalimplant 700 is disclosed. Expandable spinal implant 700 may have thesame, substantially the same, and/or similar components and attributesas spinal implants 100, 200, 300, and 600 including generalapplicability with other relevant systems and surgical tools disclosedhereinabove. Spinal implant 700 may include a screw guide endplate 7150having at least one aperture 710 configured to receive an anchoringscrew 510 therein. Screw guide endplate 7150 may be relatively longer inlength than screw guide endplate 150 discussed above and screw guideendplate 7150 may be operably coupled with moving mechanism 250similarly as explained above with respect to spinal implants 100, 200,and 300.

In the illustrated embodiment, top endplate 110 and bottom endplate 120may each have an accommodating portion 730 having a corresponding sizeand geometry to the end portions of screw guide endplate 7150 such thatwhen spinal implant 700 is in the fully collapsed position the endportions of screw guide endplate 7150 will not increase a relativeheight of implant 700 in a fully collapsed position. For example,endplates 110, 120 may fully close without being impacted by screw guideendplate 7150 and therefore maintain a relatively compact size.

FIGS. 42A and 42B illustrate an exemplary screw guide endplate 7150 withand without corresponding anchoring screws 510, respectively. FIGS. 43Aand 43B illustrate a front perspective view and a rear perspective viewof an exemplary screw guide endplate 7150 having at least one aperture710 configured to receive an anchoring screw 510 therein. In theillustrated embodiment, four apertures 710 are shown, althoughembodiments in accordance with the principles of this disclosure mayhave any number of apertures 710.

As illustrated, each aperture 710 may be configured to selectivelyreceive a corresponding anchoring screw 510 therein. The outsideentrance to each aperture 710 may define a guided path configured toorient a corresponding anchoring screw 510 in an inclined positionextending away from a proximal side of a corresponding endplate 110 or120. For example, screw guide endplate 7150 may include a total of fourapertures 710, and the four apertures 710 may include two top mostapertures 710 and two bottom most apertures 710. In the disclosedembodiment, the two top most apertures 710 may be configured to inclinea corresponding anchoring screw 510 with respect to top endplate 110that extends away from a proximal side of implant 700 towards a distalside of implant 700. Similarly, the two bottom most apertures 710 may beconfigured to incline a corresponding anchoring screw 510 with respectto bottom endplate 120 that extends from a proximal side of implant 700towards a distal side of implant 700. Corresponding orientations areillustrated in FIGS. 40, 41, and 42B which show two top anchoring screws510 oriented upward at an inclined angle with respect to top endplate110 and two bottom anchoring screws 510 oriented downward at an inclinedangle with respect to bottom endplate 120. Alternatively, the screwholes in the plate may be arranged and numbered in various alternativedesigns including, instead of two holes on top and bottom, presenting asingle hole in the center or on one side or the other on top and bottom,or two holes on one of the top or bottom and one hole on the oppositeside, top or bottom. These screw holes may further include protrusions,threads or other features to control, guide, and/or retain the screws inplace or include features such as retaining clips, springs, or covers toretain the screws in place once inserted. The screw holes may be ofvarious shapes including cylindrical, conical, or designed to receive abulbous or spherical screw head.

FIGS. 44A and 44B may illustrate a top endplate 110 and a bottomendplate 120, respectively, with an anchoring screw 510 in onecorresponding aperture 710 and without an anchoring screw 510 in theother corresponding aperture 710 for ease of explanation. Asillustrated, the top endplate 110 may include at least one anchoringscrew 510 such that it projects through or across a corresponding recess740 of the first endplate 110. Similarly, the bottom endplate 120 mayinclude at least one anchoring screw 510 such that it projects throughor across a corresponding recess 740 of the first endplate 110.

At least one advantage of the disclosed spinal implant 700 is that screwguide endplate 7150 and moving mechanism 250 may be configured such thatthe moving mechanism 250 can selectively adjust a spacing between thefirst and second endplates 110, 120 and adjust an angle of inclinationbetween the first and second endplates while the at least onecorresponding anchoring screw 510 is anchored within a correspondingvertebrae. For example, a surgeon may initially position spinal implant700 between adjacent vertebrae of a patient and install at least onecorresponding anchoring screw 510 in a first orientation projectingthrough or across a corresponding recess 740 of first endplate 110 andat least one corresponding anchoring screw 510 in a second orientationprojecting through or across recess 740 of second endplate 120. Next,the surgeon may continue to adjust the spacing and/or angle ofinclination between endplates 110, 120 until the endplates 110, 120 arein the desired position. This is possible, at least partly, because therelative location of the screw guide endplate 7150 remains fixed due tothe anchored anchoring screws 510 and the first and second endplates canfreely expand/contract and/or incline/decline via moving mechanism 250while anchoring screws 510 extend through or across recess 740 (whichhas a geometry such that anchored anchoring screws 510 do not interferewith the movement of endplates 110, 120). For example, the endplates110, 120 may freely move while anchoring screws 510 remain anchored inplace in the corresponding vertebrae.

FIGS. 45 and 46 are perspective views of an additional embodiment of anexpandable spinal implant 800 including an anterior endplate 810 inaccordance with the principles of the present disclosure. In someembodiments, anterior endplate 810 may be referred to as a thirdendplate, or may be referred to as a medial, lateral, or posteriorendplate depending upon orientation or approach employed and thespecific configuration and shape of the implant and the location, sideor end to which the third plate is affixed or located. FIG. 47 is anexploded parts view diagram of the embodiment of FIG. 45 in accordancewith the principles of the present disclosure. Expandable spinal implant800 may include the same, substantially the same, and/or similarfeatures as the various above disclosed embodiments. For example, movingmechanism 250 may operate in the same, substantially the same, and/orsimilar manner as explained above. However, implant 800 may include ananterior endplate 810, a top endplate 820 (superior endplate), and abottom endplate 830 (inferior endplate) having different characteristicsas will be explained in further detail below.

Implant 800 may include an anterior side 800 a, a posterior side 800 pand two opposing lateral sides 8001, for example. Additionally, theoutside contours of implant 800 may include a top endplate 820 (superiorendplate), bottom endplate 830 (inferior endplate) and an anteriorendplate 810 (front endplate), for example. In various embodiments, thetop endplate 820 and bottom endplate 830 may collectively define theposterior side 800 p (rear side) of implant 800. Anterior endplate 810may include a plurality of circular bone screw apertures 801, forexample. In the example embodiment, four circular bone screw apertures801 are disclosed although in other embodiments the number of bone screwapertures 801 may be more or less. For example, in some embodimentsthere may be an additional 5^(th) and 6^(th) bone screw aperture in themedial location of anterior endplate 810. In other embodiments, theremay be a total of two bone screw apertures 801 including a left bonescrew aperture 801 diagonally projecting over the top endplate 820 and aright bone screw aperture 801 diagonally projecting over the bottomendplate 820.

In various embodiments, each bone screw aperture 801 may include atleast one circular ring portion 801 a that facilitates seating of a bonescrew 511 (see FIG. 52 ) and/or facilitates the alignment of a drill ina coaxial relationship, e.g., surgical tool 500 as disclosed above. Forexample, the ring portion 801 a may define a bearing surface for seatingan inclined surface 512 of an outdented rail 513 of a head portion of abone screw 511, for example. In various embodiments, the ring portion801 a may have a size and shape generally corresponding to a size andshape of the inclined surface 512 and define an interior diameter thatis less than a cross sectional diameter of the outdented rail 513.Additionally, in various embodiments, the ring portion 801 a of bonescrew apertures 801 may allow about +/−10° and in some embodiments about+/−5° of freedom to the corresponding bone screw 511 due to the inclinedsurface 512, for example.

Anterior endplate 810 may include at least one bone screw lock 803 forpreventing bone screws 511 from backing out. For example, bone screwlock 803 may be a rotatable lock that may rotate about 90° between anopen position and a closed position to prevent bone screws 511 frombacking out, for example. In various embodiments, anterior endplate 810may include at least one attachment point 805 for connecting implant 800with a surgical tool. In the disclosed embodiment, a plurality ofattachment points 805 are distributed around screw guide aperture 807.In the disclosed embodiment, six attachment points 805 are radiallydistributed around screw guide aperture 807 although other embodimentsmay have more or less, e.g. 2, 3, 4, 5, 7 or 8.

As understood best with reference to FIG. 47 , anterior endplate 810,top endplate 820, and bottom endplate 830 may be operably coupled tomoving mechanism 250. For example, moving mechanism 250 serves as acentral attachment location for each of the endplates 810, 820, 830 andeach of the endplates 810, 820, 830 may interact independently withmoving mechanism 250, for example. In the disclosed embodiment, anteriorendplate 810 may be operably coupled to moving mechanism 250 byinserting posts 855 into a corresponding post retaining aperture 255having a size and shape configured to securely couple the two together.In various embodiments, posts 855 may extend from an inside surface ofanterior endplate 810 in a direction towards the posterior side 800 p ofimplant 800 and towards moving mechanism 250. In this way, anteriorendplate 810 is independently secured to moving mechanism 250 from topendplate 820 and bottom endplate 830, for example.

FIGS. 48A and 48B are top down views of an example bottom endplate 830of spinal implant 800. In various embodiments, bottom endplate 830 andtop endplate 820 may include the same, substantially the same, and/orsimilar characteristics. In the example illustration, bottom endplate830 may include a bone screw relief 832 for each corresponding bonescrew aperture 801. For example, bone screw relief 832 comprises anarcuate channel and/or conical channel defining a portion of the outsidesurface of endplate 830. In some embodiments, the number of bone screwreliefs 832 may be more or less. For example, a single bone screw relief832 or three bone screw reliefs 832. In some embodiments, the topendplate 820 may include a first bone screw relief 822 and the bottomendplate 830 may include a second bone screw relief 832 that projectoppositely from one another in a diametrically opposed direction.Additionally, in the top down views of FIGS. 48A and 48B it is shownthat a gap 840 (void space) exists between anterior endplate 810 andbottom endplate 830. The gap 840 between anterior endplate 810 andendplates 820, 830 may be present in both the expanded and contractedposition. For example, as shown in FIG. 48C implant 800 is in anexpanded position and a gap 840 is present between anterior endplate810, top endplate 820, and bottom endplate 830. For example still, gap840 may define a continuous discontinuity between the posterior side ofthe anterior endplate 810 and the anterior side of the top endplate 820and bottom endplate 830.

FIG. 49 is a perspective view of spinal implant 800 in an expandedconfiguration including a plurality of bone screws 511 extending overcorresponding bone screw apertures 801. In the example embodiment, whenimplant 800 is in the fully expanded position a trajectory of the bonescrews 511 is unaffected by the top endplate 820 and/or bottom endplate830. For example, the bone screw reliefs 822, 832 allow the implant 800to fully expand without interfering with bone screws 511. For examplestill, bone screws 511 may be secured to a boney surface and only anchorimplant 800 via bone screw apertures 801 of anterior endplate 810.

FIG. 50 is an alternate perspective view of the embodiment of FIG. 45including a plurality of bone screws 511 that are prevented and/orsuppressed from backing out due to bone screw locks 803. Bone screwlocks 803 may be toggled between an unlocked position shown in FIG. 49to a locked position shown in FIG. 50 by rotating the bone screw lock803 about 90°. In operation, an end user such as a surgeon may placebone screws 511 through bone screw aperture 801 after the implant 800 isexpanded to the desired height and inclination. Thereafter, the surgeonmay move bone screw lock 803 from the unlocked position to the lockedposition to prevent bone screws 511 from backing out. In variousembodiments, even after the bone screw lock 803 is engaged in the lockedposition the surgeon may drive bone screws 511. FIG. 51 is a rearperspective view of implant 800 including a plurality of bone screws511.

FIG. 52 is an example side view of a bone screw 511. As illustrated inthe embodiment of FIG. 52 , bone screw 511 may include an inclinedsurface 512 extending around the circumference of bone screw 511 andterminating into a ring portion 513. In various embodiments, the ringportion 513 may have a size and shape generally corresponding to a sizeand shape of circular ring portions 801 a of bone screw aperture 801,for example. Additionally, in various embodiments the cooperationbetween the circular ring portions 801 a, inclined surface 512 and ringportion 513 may allow about +/−5° of freedom to the corresponding bonescrew 511, for example.

FIG. 53 is a reference diagram illustrating various cardinal directionsand planes with respect to a patient that various spinal implantsdisclosed herein may operate, adjust, and/or move along in accordancewith the principles of the present disclosure.

Additional Plate/Expandable Plate Embodiments

Referring generally to FIGS. 54-69 various plates, including expandableplate embodiments for coupling to various spinal implants are disclosed.FIGS. 54-61 illustrate a first expandable plate 1500 embodiment; FIGS.62-67 illustrate a second expandable plate 1600 embodiment, and FIGS.68-73 illustrate a third expandable plate 1700 embodiment. The variousexpandable plates 1500, 1600, 1700 may have the same, similar, and/orsubstantially the same components and functionality unless the contextclearly indicates otherwise. For example, the various expandable plates1500, 1600, and 1700 may each be designed for connecting and/or couplingto the various spinal implants disclosed herein, and may be used inconjunction with anterior endplate 810, for example. However, theprinciples of the disclosed expandable plates 1500, 1600, 1700 are notnecessarily limited to the specific implants disclosed herein and can,of course, be coupled and/or connected to other implants in the same,similar, and/or substantially the same manner.

FIGS. 54-55 are various perspective views of a first expandable plate1500 embodiment for coupling to disclosed spinal implants. Expandableplate 1500 may include a superior portion 1505 (may also be referred toas superior plate) and an inferior portion 1503 (may also be referred toas an inferior plate) that are expandable and contractible relative toone another, for example. Superior portion 1505 may include a first bonescrew aperture 1502 a for supporting a first bone screw 1504 a in atarget trajectory and inferior portion 1503 may include a second bonescrew aperture 1502 b for supporting a second bone screw 1504 b in atarget trajectory, for example. Expandable plate 1500 may include an endcap 1501 that is rotatable between a locked position where the first andsecond bone screw apertures 1502 a, 1502 b are covered such that thefirst and second bone screws 1504 a, 1504 b are prevented and/orsuppressed from backing out. Expandable plate 1500 may include a setscrew 1507 for securing the superior portion 1505 and inferior portion1503 at a particular positon relative to one another. For example, thesuperior portion 1505 and inferior portion 1503 are expandable in avertical direction away from one another and set screw 1507 may lock thesuperior portion 1505 and inferior portion 1503 at any one of thevarious expanded positions.

FIG. 56 is a front view of a first expandable plate 1500 showing variousaxes and reference directions. Expandable plate 1500 may extend in alengthwise direction along axis Y-Y (may also be referred to as thevertical direction depending on orientation), for example. In variousembodiments, expandable plate 1500 may be roughly considered symmetricalon either side of axis Y-Y and/or at least because bone screw apertures1502 a and 1502 b are vertically aligned. Additionally, expandable plate1500 may extend in a widthwise direction along axis X-X (may also bereferred to as a lateral direction depending on orientation), forexample. In various embodiments, a thickness of expandable plate 1500may extend in a proximal-to-distal direction. For example, as shown inFIG. 54 , a thickness may be measured in a proximal-to-distal directionfrom proximal side 1500 p to distal side 1500 d.

FIGS. 57-59 are various exploded parts views of a first expandable plate1500. In the example embodiment, it is shown that set screw 1507 extendsin a proximal to distal direction and includes a thread pattern 1507 aon an outside circumferential surface at the distal end and a headportion 1507 b at the proximate end that is relatively larger than themaximum diameter of the thread pattern 1507 a, for example. In variousembodiments, set screw 1507 may include a hollow interior such that arotation instrument such as a driver may extend through set screw 1507in the proximal-to-distal direction. Set screw 1507 may extend throughaperture 1501 a of cover 1501, aperture 1503 a of inferior portion 1503,aperture 1505 a of superior portion 1505, and thread into the threadedaperture 1509 a of nut 1509, for example. Additionally, in variousembodiments head portion 1507 b may be nested and/or seated within acircumferential indent 1501 b such that the outside surfaces of headportion 1507 b and the outside portion of end cap 1501 are flush and/orsubstantially flush, for example. Additionally, upper portion 1505 mayinclude a lip 1505 d projecting from a distal side of upper portion 1505and extending in a widthwise direction. In various embodiments, lip 1505d may be positioned to sit on an apophyseal ring of an adjacentvertebrae and be utilized for determining an appropriate expansionsetting of the upper portion 1505 relative to the lower portion 1503,for example.

As seen best in FIG. 58 , lower portion 1503 may include a receivingcavity 1503 c having a size and shape that corresponds to a lower end ofupper portion 1505, for example. Receiving cavity 1503 c may have a sizeand shape generally corresponding to a size and shape of a lower end ofthe upper portion 1505. Lower portion 1503 may include a rack portion1503 b comprising a plurality of raised rails and indented grooves thatextend in a widthwise direction, for example. In various embodiments,rack portion 1503 b may be disposed within cavity 1503 c proximate toand on both sides of aperture 1503 a. Additionally, rack portion 1503 bmay face the proximal direction of expandable plate 1500. As seen bestin FIG. 57 , upper portion 1505 may include a rack portion 1505 bcomprising a plurality of raised rails and indented grooves that extendin a widthwise direction, for example. In various embodiments, rackportion 1505 b may be disposed on a distal end of upper portion 1505such that when upper portion 1505 is insert within receiving cavity 1503c rack portion 1505 b faces rack portion 1503 b, for example. In thisway, rack portion 1505 b may mesh with rack portion 1503 b within any ofthe various plurality of positions defined by the plurality of raisedrails and indented grooves, for example.

In various embodiments, upper portion 1505 may move up and down in avertical direction within receiving cavity 1503 c such that expandableplate 1500 may be selectively expanded and contracted. Additionally, nut1509 may nest within channel 1503 e of lower portion 1503, for example.In the example embodiment, channel 1503 e may be understood as a slottedchannel that extends in a vertical direction for a distance greater thanthe diameter of nut 1509 and extends in the widthwise direction for adistance approximating a width of nut 1509. For example, nut 1509 mayinclude planar side surfaces 1509 b and a distance in the widthwisedirection of channel 1503 e may correspond to the distance between thetwo planar side surfaces 1509 b. Additionally, planar side surfaces 1509b may prevent the nut 1509 from rotating while set screw 1507 istightened to nut 1509. Accordingly, an end user such as a surgeon mayexpand the top portion 1505 relative to the bottom portion 1503 (or viceversa) and tighten set screw 1507 to nut 1509 such that rack portions1505 b and 1503 b are urged together and/or directly engage with oneanother. In this way, an end user can securely couple the top portion1505 to the bottom portion 1503 in any one of the various viableexpanded positions.

With reference to FIGS. 59 and 61 , set screw 1507 may include a taperedportion 1507 c disposed between a circumferential indent 1507 d at aproximal side and a threaded portion 1507 a, for example. In someembodiments, tapered portion 1507 c may be referred to as a conicaltapered portion, for example. Tapered portion 1507 c may be widest at aproximal end of screw 1507 and narrowest at an end thereof closest to adistal side and before and/or adjoining threaded portion 1507 a, forexample. In various embodiments, tapered portion 1507 c, In variousembodiments, engagement surfaces of the upper portion 1505 and/or lowerportion 1503 may be seated within circumferential indent 1507 d (seeFIG. 61 ). Additionally, in various embodiments tapered portion 1507 cmay interfere with aperture 1505 a such that set screw 1507 may rotatetherein while also remaining coupled to nut 1509, for example.Additionally, tapered portion 1507 c may facilitate and/or allow theupper portion 1505 and lower portion 1503 to expand and contract whilealso allowing the cover 1501 to rotate. For example, cover 1501 mayrotate around tapered portion 1507 c between a locked position and anunlocked position.

FIG. 60 is a front view of a first expandable plate 1500 embodimentcoupled to an endplate 810 of a spinal implant 800 and FIG. 61 is across section view of FIG. 60 . In the example embodiment, it is shownthat the distal side of expandable plate 1500 is in contact with theproximal side of endplate 810. Additionally, it is shown that the firstand second set screws 252, 254 of moving mechanism 250 are accessiblethrough an aperture of set screw 1507 of expandable plate 1500.Furthermore, it is shown that a target trajectory of the first andsecond bone screws 1504 a, 1504 b extends substantially perpendicular tothe face of expandable plate 1500 in a proximal-to-distal-direction. Forexample, the first and second bone screws 1504 a, 1504 b extend straightback from the proximal end towards the distal end in a plane thatapproximates the centerline of implant 800 and expandable plate 1500.Furthermore, in various embodiments the first bone screw aperture 1502 aand second bone screw aperture 1502 b may be conically shaped, tapered,and/or cylindrical with or without a retaining lip and may also allowfor about +/−9 degrees of relative freedom of movement. In variousembodiments, in a contracted position, a vertical distance between thefirst bone screw aperture 1502 a and second bone screw aperture 1502 bmay be about 15 mm to about 25 mm and in some embodiments about 21.5 mm,for example. In various embodiments, in an expanded position, a verticaldistance between the first bone screw aperture 1502 a and second bonescrew aperture 1502 b may about 20 mm to about 35 mm and in someembodiments about 27.5 mm, for example.

FIGS. 62-63 are various perspective views of a second expandable plate1600 embodiment for coupling to disclosed spinal implants. Expandableplate 1600 may include a superior portion 1605 (may also be referred toas superior plate) and an inferior portion 1603 (may also be referred toas an inferior plate) that are expandable and contractible relative toone another, for example. Superior portion 1605 may include a first bonescrew aperture 1602 a for supporting a first bone screw 1604 a in atarget trajectory and a second bone screw aperture 1602 b for supportinga second bone screw 1604 b in a target trajectory, for example.Additionally, inferior portion 1603 may include a third bone screwaperture 1602 c for supporting a third bone screw 1604 c in a targettrajectory, for example. Expandable plate 1600 may include an end cap1601 that is rotatable between a locked position where the first,second, and third bone screw apertures 1602 a, 1602 b, and 1602 c arecovered such that the first, second, and third bone screws 1604 a, 1604b, 1604 c are prevented and/or suppressed from backing out. Expandableplate 1600 may include a set screw 1607 for securing the superiorportion 1605 and inferior portion 1603 at a particular positon relativeto one another. For example, the superior portion 1605 and inferiorportion 1603 are expandable in a vertical direction away from oneanother and set screw 1607 may lock the superior portion 1605 andinferior portion 1603 at any one of the various expanded positions aswill be explained in further detail below.

FIG. 64 is a front view of a second expandable plate 1600 showingvarious axes and reference directions. Expandable plate 1600 may extendin a lengthwise direction along axis Y-Y (may also be referred to as thevertical direction depending on orientation), for example. In variousembodiments, expandable plate 1600 may be roughly considered symmetricalon either side of axis Y-Y. For example, a left side of expandable plate1700 may be symmetrical with respect to a right side of expandable plate1700. Additionally, expandable plate 1600 may extend in a widthwisedirection along axis X-X (may also be referred to as a lateral directiondepending on orientation), for example. In various embodiments, athickness of expandable plate 1600 may extend in a proximal-to-distaldirection. For example, as shown in FIG. 62 , a thickness may bemeasured in a proximal-to-distal direction from proximal side 1600 p todistal side 1600 d.

FIG. 65 is an exploded parts view of a second expandable plate 1600. Inthe example embodiment, it is shown that set screw 1607 extends in aproximal-to-distal direction and includes a thread pattern 1607 a on anoutside circumferential surface at the distal end and a head portion1607 b at the proximate end that is relatively larger than the maximumdiameter of the thread pattern 1607 a, for example. Set screw 1607 mayextend through aperture 1601 a of cover 1601, aperture 1603 a ofinferior portion 1603, aperture 1605 a of superior portion 1605, andthread into the threaded aperture 1609 a of nut 1609, for example. Invarious embodiments, set screw 1607 may include a hollow interior suchthat a rotation instrument such as a driver may extend through set screw1607 in the proximal-to-distal direction. Additionally, in variousembodiments head portion 1607 b may be nested and/or seated within acircumferential indent 1601 b such that the outside surfaces of headportion 1607 b and the outside portion of end cap 1601 are flush and/orsubstantially flush, for example. Furthermore, upper portion 1605 mayinclude a lip 1605 d projecting from a distal side of upper portion 1605and extending in a widthwise direction. Similarly, lower portion 1603may include a lip 1603 d projecting from a distal side of lower portion1603 and extending in a widthwise direction. In various embodiments,lips 1605 d, 1603 d may be positioned to sit on an apophyseal ring of anadjacent vertebrae, respectively, and be utilized for determining anappropriate expansion setting of the upper portion 1605 relative to thelower portion 1603, for example. For example, an end user such as asurgeon may position lip 1605 d to sit and/or contact an apophyseal ringof a superior vertebrae and position lip 1603 d to sit and/or contact anapophyseal ring of an inferior vertebrae. In doing so, an appropriateexpansion and/or relative height of expandable plate 1600 may beestablished.

As seen best in FIG. 65 , upper portion 1605 may include a receivingcavity 1605 c having a size and shape that corresponds to an upper endof lower portion 1603, for example. Receiving cavity 1605 c may have asize and shape generally corresponding to a size and shape of an upperend of the lower portion 1603. Upper portion 1605 may include a rackportion 1605 b comprising a plurality of raised rails and indentedgrooves that extend in a widthwise direction, for example. In variousembodiments, rack portion 1605 b may be disposed within cavity 1605 cproximate to and on both sides of aperture 1605 a. Additionally, rackportion 1605 b may face the proximal direction of expandable plate 1600.As seen best in FIG. 65 and FIG. 67 , lower portion 1603 may include arack portion 1603 b comprising a plurality of raised rails and indentedgrooves that extend in a widthwise direction, for example. In variousembodiments, rack portion 1603 b may be disposed on a distal end oflower portion 1603 such that when lower portion 1603 is insert withinreceiving cavity 1605 c, rack portion 1603 b faces rack portion 1605 b,for example. In this way, rack portion 1603 b may mesh with rack portion1605 b within any of the various plurality of positions defined by theplurality of raised rails and indented grooves, for example.

In various embodiments, lower portion 1603 may move up and down in avertical direction within receiving cavity 1605 c such that expandableplate 1600 may be selectively expanded and contracted. Additionally, nut1609 may nest within channel 1605 e of upper portion 1605, for exampleas seen best in FIG. 67 . In the example embodiment, channel 1605 e maybe understood as a slotted channel that extends in a vertical directionfor a distance greater than the diameter of nut 1609 and extends in thewidthwise direction for a distance approximating a width of nut 1609.For example, nut 1609 may include planar side surfaces 1609 b and adistance in the widthwise direction of channel 1605 e may correspond tothe distance between the two planar side surfaces 1609 b. Additionally,planar side surfaces 1609 b may prevent the nut 1609 from rotating whileset screw 1607 is tightened to nut 1609. Accordingly, an end user suchas a surgeon may expand the bottom portion 1603 relative to the topportion 1605 (or vice versa) and tighten set screw 1607 to nut 1609 suchthat rack portions 1605 b and 1603 b are urged together and/or directlyengage with one another. In this way, an end user can securely couplethe top portion 1605 to the bottom portion 1603 in any one of thevarious viable expanded positions.

FIGS. 66 and 67 are various perspective views of a second expandableplate 1600 embodiment in an expanded position. Although not illustrated,second expandable plate 1600 may couple to an implant and/or endplate810 in the same, substantially the same, and/or similar manner asexplained above in reference to first expandable plate 1500.Accordingly, duplicative description will be omitted. In the exampleembodiment, it is shown that the first, second, and third bone screws1604 a, 1604 b, 1604 c extend from the proximal end towards the distalend in a diverging pattern. Additionally, in various embodiments, thefirst and second bone screws may converge towards one another, at leastpartially. Furthermore, in various embodiments the first bone screwaperture 1602 a, second bone screw aperture 1602 b, and third bone screwaperture 1602 c may be conically shaped, tapered, and/or cylindricalwith or without a retaining lip and may also allow for about +/−9degrees of relative freedom of movement. In various embodiments, in acontracted position, a vertical distance between the first bone screwaperture 1602 a and second bone screw aperture 1602 b may be about 16 mmto about 25 mm and in some embodiments about 21.5 mm, for example. Invarious embodiments, in an expanded position, a vertical distancebetween the first bone screw aperture 1602 a and second bone screwaperture 1602 b may be about 20 mm to about 35 mm and in someembodiments about 27.5 mm, for example.

FIGS. 68-73 are various perspective views of a third expandable plate1700 embodiment for coupling to disclosed spinal implants. Withreference to FIGS. 68 and 69 , expandable plate 1700 may include asuperior portion 1705 (may also be referred to as superior plate) and aninferior portion 1703 (may also be referred to as an inferior plate)that are expandable and contractible relative to one another, forexample. Superior portion 1705 may include a first bone screw aperture1702 a for supporting a first bone screw 1704 a in a target trajectoryand a second bone screw aperture 1702 b for supporting a second bonescrew 1704 b in a target trajectory, for example. Additionally, inferiorportion 1703 may include a third bone screw aperture 1702 c forsupporting a third bone screw 1704 c in a target trajectory, and afourth bone screw aperture 1702 d for supporting a fourth bone screw1704 d, for example. Expandable plate 1700 may include an end cap 1701that is rotatable between a locked position where the first, second,third, and fourth bone screw apertures 1702 a, 1702 b, 1702 c, and 1702d, are covered such that the first, second, third, and fourth bonescrews 1704 a, 1704 b, 1704 c, and 1702 d are prevented and/orsuppressed from backing out. Expandable plate 1700 may include a setscrew 1707 for securing the superior portion 1705 and inferior portion1703 at a particular positon relative to one another. For example, thesuperior portion 1705 and inferior portion 1703 are expandable in avertical direction away from one another and set screw 1707 may lock thesuperior portion 1705 and inferior portion 1703 at any one of thevarious expanded positions as will be explained in further detail below.

FIG. 70 is a front view of a third expandable plate 1700 showing variousaxes and reference directions. Expandable plate 1700 may extend in alengthwise direction along axis Y-Y (may also be referred to as thevertical direction depending on orientation), for example. In variousembodiments, expandable plate 1700 may be roughly considered symmetricalon either side of axis Y-Y. For example, a left side of expandable plate1700 may be symmetrical with respect to a right side of expandable plate1700. Additionally, expandable plate 1700 may extend in a widthwisedirection along axis X-X (may also be referred to as a lateral directiondepending on orientation), for example. In various embodiments, athickness of expandable plate 1700 may extend in a proximal-to-distaldirection. For example, as shown in FIG. 68 , a thickness may bemeasured in a proximal-to-distal direction from proximal side 1700 p todistal side 1700 d.

FIG. 71 is an exploded parts view of a third expandable plate 1700. Inthe example embodiment, it is shown that set screw 1707 extends in aproximal-to-distal direction and includes a thread pattern 1707 a on anoutside circumferential surface at the distal end and a head portion1707 b at the proximate end that is relatively larger than the maximumdiameter of the thread pattern 1707 a, for example. Set screw 1707 mayextend through aperture 1701 a of cover 1701, aperture 1703 a ofinferior portion 1703, aperture 1705 a of superior portion 1705, andthread into the threaded aperture 1709 a of nut 1709, for example. Invarious embodiments, set screw 1707 may include a hollow interior suchthat a rotation instrument such as a driver may extend through set screw1707 in the proximal-to-distal direction. Additionally, in variousembodiments head portion 1707 b may be nested and/or seated within acircumferential indent 1701 b such that the outside surfaces of headportion 1707 b and the outside portion of end cap 1701 are flush and/orsubstantially flush, for example. Furthermore, upper portion 1705 mayinclude a lip 1705 d projecting from a distal side of upper portion 1705and extending in a widthwise direction. Similarly, lower portion 1703may include a lip 1703 d projecting from a distal side of lower portion1703 and extending in a widthwise direction. In various embodiments,lips 1705 d, 1703 d may be positioned to sit on an apophyseal ring of anadjacent vertebrae, respectively, and be utilized for determining anappropriate expansion setting of the upper portion 1705 relative to thelower portion 1703, for example. For example, an end user such as asurgeon may position lip 1705 d to sit and/or contact an apophyseal ringof a superior vertebrae and position lip 1703 d to sit and/or contact anapophyseal ring of an inferior vertebrae. In doing so, an appropriateexpansion and/or relative height of expandable plate 1700 may beestablished.

As seen best in FIG. 71 , upper portion 1705 may include a receivingcavity 1705 c having a size and shape that corresponds to an upper endof lower portion 1703, for example. Receiving cavity 1705 c may have asize and shape generally corresponding to a size and shape of a lowerend of the upper portion 1705. Upper portion 1705 may include a rackportion 1705 b comprising a plurality of raised rails and indentedgrooves that extend in a widthwise direction, for example. In variousembodiments, rack portion 1705 b may be disposed within cavity 1705 cproximate to and on both sides of aperture 1705 a. Additionally, rackportion 1705 b may face the proximal direction of expandable plate 1700.As seen best in FIG. 71 , lower portion 1703 may include a rack portion1703 b comprising a plurality of raised rails and indented grooves thatextend in a widthwise direction, for example. In various embodiments,rack portion 1703 b may be disposed on a distal end of lower portion1703 such that when lower portion 1703 is insert within receiving cavity1705 c, rack portion 1703 b faces rack portion 1705 b, for example. Inthis way, rack portion 1703 b may mesh with rack portion 1705 b withinany of the various plurality of positions defined by the plurality ofraised rails and indented grooves, for example.

In various embodiments, lower portion 1703 may move up and down in avertical direction within receiving cavity 1705 c such that expandableplate 1700 may be selectively expanded and contracted. Additionally, nut1709 may nest within channel 1705 e of upper portion 1705, for exampleas shown in FIG. 73 . In the example embodiment, channel 1705 e may beunderstood as a slotted channel that extends in a vertical direction fora distance greater than the diameter of nut 1709 and extends in thewidthwise direction for a distance approximating a width of nut 1709.For example, nut 1709 may include planar side surfaces 1709 b and adistance in the widthwise direction of channel 1705 e may correspond tothe distance between the two planar side surfaces 1709 b. Additionally,planar side surfaces 1709 b may prevent the nut 1709 from rotating whileset screw 1707 is tightened to nut 1709. Accordingly, an end user suchas a surgeon may expand the bottom portion 1703 relative to the topportion 1705 (or vice versa) and tighten set screw 1707 to nut 1709 suchthat rack portions 1705 b and 1703 b are urged together and/or directlyengage with one another. In this way, an end user can securely couplethe top portion 1705 to the bottom portion 1703 in any one of thevarious viable expanded positions.

FIGS. 72 and 73 are various perspective views of a third expandableplate 1700 embodiment in an expanded position. Although not illustrated,third expandable plate 1700 may couple to an implant and/or endplate 810in the same, substantially the same, and/or similar manner as explainedabove in reference to first expandable plate 1500. Accordingly,duplicative description will be omitted. In the example embodiment, itis shown that the first, second, third and fourth bone screws 1704 a,1704 b, 1704 c, 1704 d extend from the proximal end towards the distalend in a converging pattern. Furthermore, in various embodiments thefirst bone screw aperture 1702 a, second bone screw aperture 1702 b,third bone screw aperture 1702 c, and fourth bone screw aperture 1702 dmay be conically shaped, tapered, and/or cylindrical with or without aretaining lip and may also allow for about +/−9 degrees of relativefreedom of movement. In various embodiments, in a contracted position, avertical distance between the first bone screw aperture 1702 a and thirdbone screw aperture 1702 b may be about 17 mm to about 25 mm and in someembodiments about 21.5 mm, for example. Similarly, in variousembodiments, in a contracted position, a vertical distance between thesecond bone screw aperture 1702 b and fourth bone screw aperture 1702 dmay be about 17 mm to about 25 mm and in some embodiments about 21.5 mm,for example. In various embodiments, in an expanded position, a verticaldistance between the first bone screw aperture 1702 a and third bonescrew aperture 1702 c may about 20 mm to about 35 mm and in someembodiments about 27.5 mm, for example. Similarly, in variousembodiments, in an expanded position, a vertical distance between thesecond bone screw aperture 1702 b and fourth bone screw aperture 1702 dmay about 20 mm to about 35 mm and in some embodiments about 27.5 mm,for example.

FIG. 74 is a flow chart method of operation 1800 for installing anexpandable plate and an expandable implant between adjacent vertebrae ofa patient. The various method steps below may be explained in thecontext of the various disclosed expandable plates 1500, 1600, and 1700.Although the various expandable plates 1500, 1600, 1700 and the variousspinal implants disclosed herein may be used to perform the method ofoperation 18000 the method of operation is not limited to theembodiments disclosed herein. Furthermore, the following steps need notbe performed in sequence and can be performed in any alternate sequencewith or without all of the disclosed method steps.

At step 1802 an expandable plate and/or an expandable spinal implant maybe provided, for example. At step 1804, an end user may prepare a spacebetween adjacent boney structures by removal and/or cleaning of thespace. For example, an end user may remove a degenerative disc between asuperior vertebrae and an inferior vertebrae. At step 1806, an end usermay insert the spinal implant between the superior vertebrae andinferior vertebrae. In some embodiments, the spinal implant andexpandable plate may be simultaneously insert into the patient anatomy,although the spinal implant may be insert within the disc space betweenthe superior and inferior vertebrae while the expandable plate remainson the outside of the disc space. At step 1808, an end user may installat least one bone screw in a boney structure. For example, an end usermay install a bone screw that extends through an upper portion and/orlower portion of an expandable plate. In various embodiments, the atleast one bone screw may be partially installed, i.e., the one screw maynot be fully tightened into the patient anatomy. At step 1810, an enduser may expand the expandable plate and/or spinal implant. For example,an end user may insert an inserter through a set screw of the expandableplate and activate an expansion mechanism inside of the spinal implantto effectuate expansion of the spinal implant within the disc space.Additionally, an end user may move the upper portion and/or lowerportion to expand the expandable plate on the outside of the disc space.At step 1812, an end user may position a portion of the expandable plateagainst an apophyseal ring. For example, an end user may ensure that alip portion of at least one of the upper portion and/or lower portionabuts an apophyseal ring of a corresponding vertebrae. At step 1814, anend user may fully tighten any remaining bone screws to be installed.For example, an end user may tighten any remaining bone screws of anexpandable plate and/or any remaining bone screws of a spinal implant.

What is claimed is:
 1. An expandable plate deployable between acontracted position and an expanded position, comprising: an expandablebody having a thickness in a proximal-to-distal direction between aproximal end and a distal end, a width in a widthwise direction, and aheight in a longitudinal direction, the expandable body comprising afirst portion and a second portion; wherein the first portion includes:a receiving cavity facing the proximal end, and a first through apertureextending in the proximal-to-distal direction, wherein the secondportion includes: a lower end having a size and shape that correspondsto the receiving cavity, and a second through aperture extending in theproximal-to-distal direction, a locking screw; and a nut, wherein, in alocked position, the locking screw extends through the first throughaperture and the second through aperture, and is secured to the nut, andwherein the expandable plate is configured to couple to a proximal faceof an intervertebral spinal implant via the locking screw.
 2. Theexpandable plate of claim 1, wherein: the receiving cavity comprises afirst rack portion comprising a plurality of raised rails and indentedgrooves; and a distal end of the second portion comprises a second rackportion comprising a plurality of raised rails and indented grooves. 3.The expandable plate of claim 2, wherein, in the locked position, thefirst rack portion and second rack portion are directly engaged.
 4. Theexpandable plate of claim 1, wherein the first portion comprises a firstbone screw aperture and the second portion comprises a second bone screwaperture.
 5. The expandable plate of claim 4, wherein the locking screwcomprises a tapered portion.
 6. The expandable plate of claim 1, whereina distal end of the second portion comprises a slotted aperture.
 7. Theexpandable plate of claim 6, wherein the nut is disposed within theslotted aperture.
 8. The expandable plate of claim 7, wherein the nutcomprises a first planar side surface and a second planar side surfaceopposite the first planar side surface.
 9. The expandable plate of claim8, wherein: a first distance of the slotted aperture extends in thewidthwise direction; a second distance of the nut extends between thefirst planar side surface and the second planar side surface; and thefirst distance approximates the second distance.
 10. The expandableplate of claim 1, wherein: the receiving cavity comprises a first rackportion comprising a plurality of raised rails and indented grooves; andthe first through aperture extends through the first rack portion. 11.The expandable plate of claim 10, wherein: a distal end of the secondportion comprises a second rack portion comprising a plurality of raisedrails and indented grooves; and the second through aperture extendsthrough the second rack portion.
 12. The expandable plate of claim 1,comprising: a rotatable end cap, and wherein the first portion comprisesa first bone screw aperture configured to orient a first bone screw in atarget trajectory and the second portion comprises a second bone screwaperture configured to orient a second bone screw in a targettrajectory.
 13. The expandable plate of claim 12, wherein, in a firstposition, the end cap is positioned such that the first bone screwaperture and second bone screw aperture are accessible.
 14. Theexpandable plate of claim 13, wherein, in a second position, the end capis positioned such that the first bone screw aperture and second bonescrew aperture are blocked.
 15. The expandable plate of claim 1,wherein: the expandable body comprises a longitudinal axis crossing overa center of the expandable body in the longitudinal direction, and theexpandable body is substantially symmetrical with respect to thelongitudinal axis.
 16. The expandable plate of claim 1, wherein: theintervertebral spinal implant comprises an expansion mechanism includingat least one set screw configured to expand the intervertebral spinalimplant, and the locking screw includes a central aperture extendingtherethrough and being configured to allow a drive tool to extendthrough the central aperture for rotating the at least one set screw.17. A method for installing an expandable plate and an expandable spinalimplant, comprising: providing an expandable spinal implant; providingan expandable plate, the expandable plate including: an expandable bodyhaving a thickness in a proximal-to-distal direction between a proximalend and a distal end, a width in a widthwise direction, and a height ina longitudinal direction, the expandable body comprising a first portionand a second portion; wherein the first portion includes: a receivingcavity facing the proximal end, a first bone screw aperture, and a firstthrough aperture extending in the proximal-to-distal direction, whereinthe second portion includes: a lower end having a size and shape thatcorresponds to the receiving cavity, a second bone screw aperture, and asecond through aperture extending in the proximal-to-distal direction, alocking screw; and a nut, wherein, in a locked position, the lockingscrew extends through the first through aperture and second throughaperture, and is secured to the nut, and wherein the expandable plate isconfigured to couple to a face of the expandable spinal implant via thelocking screw; inserting the expandable spinal implant between adjacentboney structures; installing a first bone screw that extends througheither one of the first bone screw aperture and second bone screwaperture; and coupling the expandable plate to the face of theexpandable spinal implant via the locking screw.
 18. The method of claim17, further comprising: expanding the expandable plate; and expandingthe expandable spinal implant.
 19. The method of claim 17, furthercomprising positioning a lip portion of the expandable plate against anapophyseal ring of a patient.
 20. The method of claim 17, furthercomprising removing a degenerative portion of a patient anatomy.